Provider Demographics
NPI:1790887842
Name:SMITH, ALMA DELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALMA
Middle Name:DELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15712
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-0014
Mailing Address - Country:US
Mailing Address - Phone:617-236-7711
Mailing Address - Fax:617-236-7712
Practice Address - Street 1:60 CHARLESGATE W
Practice Address - Street 2:SUITE 1-C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2130
Practice Address - Country:US
Practice Address - Phone:617-738-4814
Practice Address - Fax:617-236-7712
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2648103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002648OtherTUFTS HEALTH PLAN
MAW02725OtherBLUE CROSS BLUE SHIELD
MAW02725OtherBLUE CROSS BLUE SHIELD