Healthcare Provider Details

I. General information

NPI: 1013955384
Provider Name (Legal Business Name): NANCY SUE WILLIAMSON SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 DOUGLAS AVE STE.2255M
ALTAMONTE SPRINGS FL
32714-2569
US

IV. Provider business mailing address

1013 CATHY DR
ALTAMONTE SPRINGS FL
32714-7216
US

V. Phone/Fax

Practice location:
  • Phone: 407-682-6992
  • Fax: 407-788-3075
Mailing address:
  • Phone: 407-788-3075
  • Fax: 407-788-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: