Provider Demographics
NPI:1184302325
Name:SMOLA, ANDREA SOPHIA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SOPHIA
Last Name:SMOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4384 NW 67TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3048
Mailing Address - Country:US
Mailing Address - Phone:754-302-5846
Mailing Address - Fax:
Practice Address - Street 1:4384 NW 67TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3048
Practice Address - Country:US
Practice Address - Phone:754-302-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician