Provider Demographics
NPI:1831440627
Name:SMITH, LAURA J (LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
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 1:8 ESSEX CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2964
Mailing Address - Country:US
Mailing Address - Phone:978-605-4428
Mailing Address - Fax:978-849-6306
Practice Address - Street 1:77 MALDEN ST APT 2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5355
Practice Address - Country:US
Practice Address - Phone:781-215-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1220711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287OtherMBHP
MA1004745OtherNHP
MA1303287Medicaid
MAM18633OtherBCBS
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
042611055OtherTAX ID