Provider Demographics
NPI:1083580591
Name:J.L SMITH SUICIDE PREVENTION CENTER FOR YOUNG BLACK BOYS INC
Entity type:Organization
Organization Name:J.L SMITH SUICIDE PREVENTION CENTER FOR YOUNG BLACK BOYS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-ST. CYERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-204-5006
Mailing Address - Street 1:66 MONADNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2306
Mailing Address - Country:US
Mailing Address - Phone:781-204-5006
Mailing Address - Fax:
Practice Address - Street 1:66 MONADNOCK ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-2306
Practice Address - Country:US
Practice Address - Phone:781-204-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health