Provider Demographics
NPI:1013955384
Name:SMITH, NANCY SUE WILLIAMSON (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE WILLIAMSON
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 1:1013 CATHY DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7216
Mailing Address - Country:US
Mailing Address - Phone:407-788-3075
Mailing Address - Fax:407-788-3075
Practice Address - Street 1:455 DOUGLAS AVE
Practice Address - Street 2:STE.2255M
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2569
Practice Address - Country:US
Practice Address - Phone:407-682-6992
Practice Address - Fax:407-788-3075
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW29151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7989Medicare ID - Type Unspecified
FLOTH000Medicare UPIN