Provider Demographics
NPI:1790826857
Name:SMITH, MAUREEN C
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:J
Other - Last Name:JETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:23 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2767
Mailing Address - Country:US
Mailing Address - Phone:781-395-0928
Mailing Address - Fax:
Practice Address - Street 1:140 COMMONWEALTH AVE STE 210
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3625
Practice Address - Country:US
Practice Address - Phone:978-532-5444
Practice Address - Fax:978-532-6366
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10169541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical