Provider Demographics
NPI:1083253934
Name:SMITH, MERLENE
Entity Type:Individual
Prefix:
First Name:MERLENE
Middle Name:
Last Name:SMITH
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 1:2100 SE HILLMOOR DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8057
Mailing Address - Country:US
Mailing Address - Phone:772-380-9972
Mailing Address - Fax:772-380-9976
Practice Address - Street 1:2100 SE HILLMOOR DR STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8057
Practice Address - Country:US
Practice Address - Phone:772-380-9972
Practice Address - Fax:772-380-9976
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker