Provider Demographics
NPI:1184239808
Name:SMIGIELSKI, MORGAN ELEANOR
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELEANOR
Last Name:SMIGIELSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PARK DR APT 18
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5238
Mailing Address - Country:US
Mailing Address - Phone:414-840-2312
Mailing Address - Fax:
Practice Address - Street 1:65 PARK DR APT 18
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5238
Practice Address - Country:US
Practice Address - Phone:414-840-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist