Provider Demographics
NPI:1922246743
Name:METZGER SMITH, CARYN (CNS)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:METZGER SMITH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:CARYN
Other - Middle Name:
Other - Last Name:METZGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS
Mailing Address - Street 1:170 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3735
Mailing Address - Country:US
Mailing Address - Phone:617-619-5903
Mailing Address - Fax:617-971-3853
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-619-5903
Practice Address - Fax:617-971-3853
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN272217364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000916301Medicare PIN