Individual ProviderJacqueline SmithCounselorBehavioral Health & Social Service ProvidersPractice Address40 Dimock Services, Roxbury, MA 02119-0000(617) 442-8800PECOS EnrollmentBased on the most recent information from CMS, provider Jacqueline Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1255710851Provider TypeIndividualFull NameSmith, JacquelineTitleMs.GenderFemaleSole ProprietorYesEnumeration Date5/28/2015Last Updated5/28/2015Contact InformationPractice LocationPractice Address40 Dimock Services, Roxbury, MA 02119-0000Phone(617) 442-8800Fax(617) 442-6268Mailing LocationMailing Address40 Dimock Services, Roxbury, MA 02119-0000Phone(617) 442-8800Fax(617) 442-6268Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode324500000XDescriptionSubstance Abuse Rehabilitation FacilityResidential Treatment FacilitiesLicenseUnlisted Issuer