Provider Demographics
NPI:1710127444
Name:SMALL, ANNIE ROSEANNA (LMHC INTERN)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:ROSEANNA
Last Name:SMALL
Suffix:
Gender:F
Credentials:LMHC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2714
Mailing Address - Country:US
Mailing Address - Phone:617-945-9331
Mailing Address - Fax:
Practice Address - Street 1:5 SACRAMENTO ST.
Practice Address - Street 2:THE GUIDANCE CENTER, INC.
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-354-2275
Practice Address - Fax:617-547-4356
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program