Provider Demographics
NPI:1639190283
Name:BERSON-SMITH, ANNETTE M (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:M
Last Name:BERSON-SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PAMELA LN
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-1007
Mailing Address - Country:US
Mailing Address - Phone:617-413-0376
Mailing Address - Fax:
Practice Address - Street 1:800 CUMMINGS CTR
Practice Address - Street 2:SUITE 266T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6175
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000903401OtherMEDICARE