Provider Demographics
NPI:1821681040
Name:SMITH, PATRICIA OUTEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:OUTEN
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 1:100 DEERFIELD PRESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5966
Mailing Address - Country:US
Mailing Address - Phone:904-829-0814
Mailing Address - Fax:
Practice Address - Street 1:100 DEERFIELD PRESERVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5966
Practice Address - Country:US
Practice Address - Phone:904-829-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW181381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical