Provider Demographics
NPI:1164065199
Name:SMITH, CHERISH ANNE
Entity Type:Individual
Prefix:MRS
First Name:CHERISH
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERISH
Other - Middle Name:ANNE
Other - Last Name:TRAVNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5707 N 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4350
Mailing Address - Country:US
Mailing Address - Phone:813-272-2244
Mailing Address - Fax:813-272-3766
Practice Address - Street 1:5707 N 22ND STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4350
Practice Address - Country:US
Practice Address - Phone:813-272-2244
Practice Address - Fax:813-272-3766
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2023-10-12
Deactivation Date:2023-08-14
Deactivation Code:
Reactivation Date:2023-10-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician