Provider Demographics
NPI:1124543962
Name:SMITH, YALILY PEREZ (LCSW)
Entity Type:Individual
Prefix:
First Name:YALILY
Middle Name:PEREZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3910
Mailing Address - Country:US
Mailing Address - Phone:321-246-7075
Mailing Address - Fax:800-948-3094
Practice Address - Street 1:303 NE 3RD AVE STE 7&8
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2538
Practice Address - Country:US
Practice Address - Phone:321-246-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical