Provider Demographics
NPI:1386776938
Name:SMITH-DISCIULLO, DEBBIE (BS, EDUCATION)
Entity type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:
Last Name:SMITH-DISCIULLO
Suffix:
Gender:F
Credentials:BS, EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COTTING ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4301
Mailing Address - Country:US
Mailing Address - Phone:781-391-1919
Mailing Address - Fax:
Practice Address - Street 1:22 CHURCH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-2718
Practice Address - Country:US
Practice Address - Phone:781-306-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator