Provider Demographics
NPI:1588362115
Name:SMOOT, TANERA
Entity type:Individual
Prefix:
First Name:TANERA
Middle Name:
Last Name:SMOOT
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 1:12 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 MILTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-1717
Practice Address - Country:US
Practice Address - Phone:774-503-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health