Provider Demographics
NPI:1972735348
Name:SMITH, MARCIA R (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SAMOSET AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-2354
Mailing Address - Country:US
Mailing Address - Phone:617-650-6328
Mailing Address - Fax:
Practice Address - Street 1:62 DERBY ST
Practice Address - Street 2:SUITE 13
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3728
Practice Address - Country:US
Practice Address - Phone:781-749-4600
Practice Address - Fax:781-741-8341
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1110211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical