Provider Demographics
NPI:1083390389
Name:SMITH, MARTHA (LMHC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PALERMO PL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2840
Mailing Address - Country:US
Mailing Address - Phone:941-504-9588
Mailing Address - Fax:
Practice Address - Street 1:1505 TAMIAMI TRL S STE 401A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5562
Practice Address - Country:US
Practice Address - Phone:941-525-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health