Provider Demographics
NPI:1053190645
Name:SMITH, ABIGAIL BOWMAN
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:BOWMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:528 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4972
Mailing Address - Country:US
Mailing Address - Phone:617-383-1019
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST STE G20
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-658-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst