Provider Demographics
NPI:1952690232
Name:SMITH, LARRY J (LCSW CAP)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47443 HIBISCUS RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:FL
Mailing Address - Zip Code:32702-9365
Mailing Address - Country:US
Mailing Address - Phone:407-617-8699
Mailing Address - Fax:
Practice Address - Street 1:114 N SAINT CLAIR ABRAMS AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3258
Practice Address - Country:US
Practice Address - Phone:407-617-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 3110101YA0400X
FLSW101141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)