Provider Demographics
NPI:1922339084
Name:SMITH, BETTY ROSE (MAED)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CODMAN PARK
Mailing Address - Street 2:#3
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1665
Mailing Address - Country:US
Mailing Address - Phone:617-445-0384
Mailing Address - Fax:
Practice Address - Street 1:5 CODMAN PARK
Practice Address - Street 2:#3
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1665
Practice Address - Country:US
Practice Address - Phone:617-445-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor