Provider Demographics
NPI:1336459783
Name:SMITH-DICKENS, SANDRA E (MED)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:E
Last Name:SMITH-DICKENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MORTON VILLAGE DRIVE APT. 406
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126
Mailing Address - Country:US
Mailing Address - Phone:617-391-9333
Mailing Address - Fax:671-983-0351
Practice Address - Street 1:170 MORTON STREET
Practice Address - Street 2:JAMAICA PLAIN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-391-9333
Practice Address - Fax:617-983-0351
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)