Provider Demographics
NPI:1114268521
Name:SMITH, ALEXANDER (LCSW, BCABA)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 N DALE MABRY HWY STE 12
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1580
Mailing Address - Country:US
Mailing Address - Phone:813-422-0073
Mailing Address - Fax:813-931-4609
Practice Address - Street 1:8910 N DALE MABRY HWY STE 12
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1580
Practice Address - Country:US
Practice Address - Phone:813-422-0073
Practice Address - Fax:813-931-4609
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-10
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-07-2351103K00000X
FLSW112231041C0700X
FL9779261041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766714100Medicaid