Provider Demographics
NPI:1093821043
Name:SMITH, ALAN P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 N. WICKHAM ROAD
Mailing Address - Street 2:SUITE 12 PMB 501
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7522
Mailing Address - Country:US
Mailing Address - Phone:321-757-4030
Mailing Address - Fax:
Practice Address - Street 1:2588 ADDINGTON CIR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6509
Practice Address - Country:US
Practice Address - Phone:321-757-4030
Practice Address - Fax:321-369-9836
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0087031041C0700X
NYR040648-11041C0700X
FLSW120161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0049Medicare UPIN
FLIA922ZMedicare UPIN