Provider Demographics
NPI:1235591868
Name:SMITH, MARISA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:TAKAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5319 GAVELLA COVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221
Mailing Address - Country:US
Mailing Address - Phone:941-479-1334
Mailing Address - Fax:
Practice Address - Street 1:5319 GAVELLA COVE
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221
Practice Address - Country:US
Practice Address - Phone:941-479-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW135471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical