Provider Demographics
NPI:1972875086
Name:SMITH, ELEANOR VALERIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:VALERIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 CAPE CORAL PKWY W
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6044
Mailing Address - Country:US
Mailing Address - Phone:239-826-1457
Mailing Address - Fax:239-540-7292
Practice Address - Street 1:2839 CAPE CORAL PKWY W
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6044
Practice Address - Country:US
Practice Address - Phone:239-826-1457
Practice Address - Fax:239-540-7292
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X, 1041C0700X, 174400000X
FLEMT536553146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No174400000XOther Service ProvidersSpecialist