Provider Demographics
NPI:1902810930
Name:SMITH, JENNA RACHELLE WRIGHT (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:RACHELLE WRIGHT
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:WRIGHT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:53 MARION RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1406
Mailing Address - Country:US
Mailing Address - Phone:508-295-8622
Mailing Address - Fax:
Practice Address - Street 1:53 MARION RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1406
Practice Address - Country:US
Practice Address - Phone:508-295-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical