Provider Demographics
NPI:1710439690
Name:SMITH MENTAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:SMITH MENTAL HEALTH ASSOCIATES
Other - Org Name:SMITH COMMUNITY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY CO-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREIA-KENT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-321-2296
Mailing Address - Street 1:601 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4054
Mailing Address - Country:US
Mailing Address - Phone:954-321-2296
Mailing Address - Fax:954-321-5399
Practice Address - Street 1:601 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4054
Practice Address - Country:US
Practice Address - Phone:954-321-2296
Practice Address - Fax:954-321-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070164500Medicaid