Provider Demographics
NPI:1710454335
Name:SMITH, LATONYA (MA)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 CLARCONA OCOEE RD UNIT 124
Mailing Address - Street 2:
Mailing Address - City:CLARCONA
Mailing Address - State:FL
Mailing Address - Zip Code:32710-2001
Mailing Address - Country:US
Mailing Address - Phone:321-437-3715
Mailing Address - Fax:407-567-7011
Practice Address - Street 1:3001 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3752
Practice Address - Country:US
Practice Address - Phone:321-437-3715
Practice Address - Fax:407-567-7044
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023801100Medicaid