Provider Demographics
NPI:1386178671
Name:SMITH, CAROLYN DELOIS
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DELOIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 SUMMIT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-9110
Mailing Address - Country:US
Mailing Address - Phone:561-983-3294
Mailing Address - Fax:561-337-9025
Practice Address - Street 1:2001 PALM BEACH LAKES BLVD
Practice Address - Street 2:300-D
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6510
Practice Address - Country:US
Practice Address - Phone:561-337-4338
Practice Address - Fax:561-337-9025
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker