NPIMap

Organization Active NPI

Theresa M Smith

  • Mental Health Counselor
  • Brockton, MA
National Provider Identifier
1265862791
Registry record updated Nov 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
RN/NP115563 Issued in MA
Legal business name
THERESA M SMITH
Doing business as
South of Boston Healing
Practice address
820 Pearl St
Brockton, MA 02301-4411
Phone
(508) 583-9800
Fax
(508) 583-9802
NPI assigned
Nov 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheryl A Puopolo
Title
Administrative Assistant
Phone
(508) 583-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X RN/NP115563 MA Primary

Addresses

Primary practice location

820 Pearl St
Brockton, MA 02301-4411

Mailing address

820 Pearl St
Brockton, MA 02301-4411
Phone (508) 583-9800

Other names 1

  • South of Boston Healing Doing business as

National Provider Directory

National Provider Directory

Locations

820 Pearl St
Brockton, MA 02301
Phone (508) 583-9800

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1265862791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 PEARL ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014411",
            "telephone_number": "508-583-9800",
            "fax_number": "508-583-9802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 PEARL ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014411",
            "telephone_number": "508-583-9800",
            "fax_number": "508-583-9802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA M SMITH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-19",
        "last_updated": "2013-11-19",
        "status": "A",
        "authorized_official_last_name": "PUOPOLO",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "508-583-9800"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "RN/NP115563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South of Boston Healing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.