Provider Demographics
NPI:1134548837
Name:ALEXANDER C. SMITH LCSW BCABA
Entity type:Organization
Organization Name:ALEXANDER C. SMITH LCSW BCABA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSSW, BCABA
Authorized Official - Phone:813-422-0073
Mailing Address - Street 1:8910 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1591
Mailing Address - Country:US
Mailing Address - Phone:813-422-0073
Mailing Address - Fax:
Practice Address - Street 1:8910 N DALE MABRY HWY
Practice Address - Street 2:SUITE 12
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1591
Practice Address - Country:US
Practice Address - Phone:813-422-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-07-2351103K00000X
NY069781104100000X
FL9779261041S0200X
FLSW112231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766714100Medicaid
FLHK291AOtherMEDICAIRE PTAN
FL1114268521OtherINDIVIDUAL NPI