Provider Demographics
NPI:1881620987
Name:LANDWIRTH, LISA SMOKLER (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:SMOKLER
Last Name:LANDWIRTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 PALMA VISTA LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2863
Mailing Address - Country:US
Mailing Address - Phone:813-933-9575
Mailing Address - Fax:813-908-8258
Practice Address - Street 1:7827 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3849
Practice Address - Country:US
Practice Address - Phone:813-935-5325
Practice Address - Fax:813-935-5325
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6022Medicare ID - Type Unspecified