Provider Demographics
NPI:1780120907
Name:G.SMART BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:G.SMART BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-690-1016
Mailing Address - Street 1:8526 CATALINA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1700
Mailing Address - Country:US
Mailing Address - Phone:813-690-1016
Mailing Address - Fax:
Practice Address - Street 1:8526 CATALINA DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1700
Practice Address - Country:US
Practice Address - Phone:813-690-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11533103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017419800Medicaid