Provider Demographics
NPI:1225828007
Name:SMITH, JEFFREY RUSTY
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RUSTY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 NE 1ST ST APT 106
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5490
Mailing Address - Country:US
Mailing Address - Phone:708-701-0352
Mailing Address - Fax:
Practice Address - Street 1:3185 BOUTWELL RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-2610
Practice Address - Country:US
Practice Address - Phone:561-621-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)