Provider Demographics
NPI:1356656284
Name:SMITH, TERESA CARLA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:CARLA
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 1:213 CRAWFORD RD # 1
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-2303
Mailing Address - Country:US
Mailing Address - Phone:407-619-5751
Mailing Address - Fax:
Practice Address - Street 1:213 CRAWFORD RD # 1
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-2303
Practice Address - Country:US
Practice Address - Phone:407-619-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical