Provider Demographics
NPI:1093099079
Name:SMITH, OLDEN O (MA)
Entity Type:Individual
Prefix:MR
First Name:OLDEN
Middle Name:O
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 NW 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5452
Mailing Address - Country:US
Mailing Address - Phone:954-300-5852
Mailing Address - Fax:954-485-4391
Practice Address - Street 1:1520 NW 55TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5452
Practice Address - Country:US
Practice Address - Phone:954-300-5852
Practice Address - Fax:954-485-4391
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor