MEDICARE: LORI SMITH, LCSW, LLC

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	SW5960	FL

General Provider Information

NPI Number	:	1487090080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORI SMITH, LCSW, LLC

Provider Business Mailing Address
First Line	:	1720 S ORANGE AVE
Second Line	:	SUITE 501
City	:	ORLANDO
State	:	FL
Zip	:	32806-2945
Country	:	US
Telephone Number	:	407-760-7395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 S ORANGE AVE
Second Line	:	SUITE 501
City	:	ORLANDO
State	:	FL
Zip	:	32806-2945
Country	:	US
Telephone Number	:	407-760-7395
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LORI SELWYN SMITH
Credential	:	LCSW
Telephone Number	:	407-760-7395

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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