Provider Demographics
NPI:1407083702
Name:DEBORAH SMITH LCSW PA
Entity Type:Organization
Organization Name:DEBORAH SMITH LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-232-1689
Mailing Address - Street 1:7617 CITA LN UNIT 102
Mailing Address - Street 2:MAIL STATION 2, BOX 11
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6216
Mailing Address - Country:US
Mailing Address - Phone:727-232-1689
Mailing Address - Fax:866-595-8350
Practice Address - Street 1:7617 CITA LN UNIT 102
Practice Address - Street 2:MAIL STATION 2, BOX 11
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6216
Practice Address - Country:US
Practice Address - Phone:727-232-1689
Practice Address - Fax:866-595-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768390100Medicaid