Provider Demographics
NPI: | 1023091527 |
---|---|
Name: | SMALL, FRANKIE ANNE (EDD EDS MSW LCSW) |
Entity type: | Individual |
Prefix: | DR |
First Name: | FRANKIE |
Middle Name: | ANNE |
Last Name: | SMALL |
Suffix: | |
Gender: | F |
Credentials: | EDD EDS MSW LCSW |
Other - Prefix: | |
Other - First Name: | FRANKIE |
Other - Middle Name: | ANNE |
Other - Last Name: | CARTLEDGE SMALL |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | EDDEDSMSWLCSW |
Mailing Address - Street 1: | 137 S PEBBLE BEACH BLVD STE 202A |
Mailing Address - Street 2: | |
Mailing Address - City: | SUN CITY CENTER |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33573-5708 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 850-232-2148 |
Mailing Address - Fax: | 813-330-3339 |
Practice Address - Street 1: | 137 S PEBBLE BEACH BLVD STE 202A |
Practice Address - Street 2: | |
Practice Address - City: | SUN CITY CENTER |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33573-5708 |
Practice Address - Country: | US |
Practice Address - Phone: | 850-232-2148 |
Practice Address - Fax: | 813-330-3339 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-11-29 |
Last Update Date: | 2023-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | SW7578 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 015947500 | Medicaid | |
FL | Z071JY | Medicare UPIN |