Provider Demographics
NPI:1710075809
Name:SMITH, JULIANN (LMHC)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:552 MASSACHUSETTS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4088
Mailing Address - Country:US
Mailing Address - Phone:617-821-6029
Mailing Address - Fax:
Practice Address - Street 1:552 MASSACHUSETTS AVE STE 202
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4088
Practice Address - Country:US
Practice Address - Phone:617-821-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health