Healthcare Provider Details

I. General information

NPI: 1396655726
Provider Name (Legal Business Name): CHELSEY SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S FLAMINGO RD STE 106 #720
DAVIE FL
33330-1902
US

IV. Provider business mailing address

4301 S FLAMINGO RD STE 106 #720
DAVIE FL
33330-1902
US

V. Phone/Fax

Practice location:
  • Phone: 857-492-9203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27128
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: