Provider Demographics
NPI:1336772656
Name:SMITH, LAUREN RACHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RACHELLE
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 1:10105 BERRYESSA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-9312
Mailing Address - Country:US
Mailing Address - Phone:901-212-3435
Mailing Address - Fax:
Practice Address - Street 1:275 4TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3205
Practice Address - Country:US
Practice Address - Phone:727-304-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical