Healthcare Provider Details

I. General information

NPI: 1427705375
Provider Name (Legal Business Name): NATASHA SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4186 LAGOON SHORE DR
LAKE WORTH FL
33467-8605
US

IV. Provider business mailing address

4186 LAGOON SHORE DR
LAKE WORTH FL
33467-8605
US

V. Phone/Fax

Practice location:
  • Phone: 561-275-9178
  • Fax:
Mailing address:
  • Phone: 561-275-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: