Provider Demographics
NPI:1275894552
Name:SMITH, KATY PATRICIA (MA)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:PATRICIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E CONCORD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4646
Mailing Address - Country:US
Mailing Address - Phone:407-756-5072
Mailing Address - Fax:
Practice Address - Street 1:811 E CONCORD ST APT 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4646
Practice Address - Country:US
Practice Address - Phone:407-756-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health