Provider Demographics
NPI:1801605951
Name:SMITH, SHERINE
Entity type:Individual
Prefix:
First Name:SHERINE
Middle Name:
Last Name:SMITH
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 1:932 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2543
Mailing Address - Country:US
Mailing Address - Phone:954-210-0833
Mailing Address - Fax:888-419-0594
Practice Address - Street 1:4701 N FEDERAL HWY STE 460
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6591
Practice Address - Country:US
Practice Address - Phone:954-866-1430
Practice Address - Fax:888-419-0594
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-402882106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician