Provider Demographics
NPI:1285181636
Name:SMIDOVA, EVA (MA PHDR)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:
Last Name:SMIDOVA
Suffix:
Gender:F
Credentials:MA PHDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 ANCHOR RODE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2739
Mailing Address - Country:US
Mailing Address - Phone:239-247-4231
Mailing Address - Fax:239-403-0548
Practice Address - Street 1:2503 DEL PRADO BLVD S
Practice Address - Street 2:410
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5791
Practice Address - Country:US
Practice Address - Phone:239-247-4231
Practice Address - Fax:239-403-0548
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist