MEDICARE: LINDA A SMITH L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW7789	FL
2	1041C0700X	Clinical Social Worker	R057520-01	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265532956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA A SMITH L.C.S.W.

Provider Business Mailing Address
First Line	:	2542 SE WELSH ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-5240
Country	:	US
Telephone Number	:	772-871-5546
Fax Number	:	772-871-5546

Provider Business Practice Location Address
First Line	:	2542 SE WELSH ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-5240
Country	:	US
Telephone Number	:	772-871-5546
Fax Number	:	772-871-5546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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