Provider Demographics
NPI:1578786455
Name:SMITH, LORI SELWYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SELWYN
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 1:178 MILEHAM DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-4419
Mailing Address - Country:US
Mailing Address - Phone:407-293-8868
Mailing Address - Fax:
Practice Address - Street 1:2180 N PARK AVE
Practice Address - Street 2:SUITE 328
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2359
Practice Address - Country:US
Practice Address - Phone:407-760-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 59601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical