Provider Demographics
NPI:1487794970
Name:SMITH, MOLLY S (PH D)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2903
Mailing Address - Country:US
Mailing Address - Phone:781-944-1194
Mailing Address - Fax:781-944-6535
Practice Address - Street 1:36 WOBURN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2903
Practice Address - Country:US
Practice Address - Phone:781-944-1194
Practice Address - Fax:781-944-9310
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4570103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist