Provider Demographics
NPI:1548510621
Name:SMITH, SERENA M
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:M
Last Name:SMITH
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 1:181 UNION STREET
Mailing Address - Street 2:SUITE J
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901
Mailing Address - Country:US
Mailing Address - Phone:508-942-4196
Mailing Address - Fax:
Practice Address - Street 1:181 UNION STREET
Practice Address - Street 2:SUITE J
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901
Practice Address - Country:US
Practice Address - Phone:508-942-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health