Provider Demographics
NPI:1124146527
Name:BARRY-SMITH, LORI A (LICSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:BARRY-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 1:37 SILK ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3818
Mailing Address - Country:US
Mailing Address - Phone:781-641-4649
Mailing Address - Fax:
Practice Address - Street 1:88 LINCOLN ST
Practice Address - Street 2:WAYSIDE METROWEST COUNSELING CENTER
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6354
Practice Address - Country:US
Practice Address - Phone:508-620-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1116581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABA P23132Medicare ID - Type Unspecified