Healthcare Provider Details

I. General information

NPI: 1972875086
Provider Name (Legal Business Name): ELEANOR VALERIE SMITH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2012
Last Update Date: 02/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2839 CAPE CORAL PKWY W
CAPE CORAL FL
33914-6044
US

IV. Provider business mailing address

2839 CAPE CORAL PKWY W
CAPE CORAL FL
33914-6044
US

V. Phone/Fax

Practice location:
  • Phone: 239-826-1457
  • Fax: 239-540-7292
Mailing address:
  • Phone: 239-826-1457
  • Fax: 239-540-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT536553
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: