Healthcare Provider Details

I. General information

NPI: 1780003814
Provider Name (Legal Business Name): JENNIFER SMITH RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SW 20TH CT
OCALA FL
34471-8885
US

IV. Provider business mailing address

6990 SE 122ND LN
BELLEVIEW FL
34420-4541
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-0450
  • Fax:
Mailing address:
  • Phone: 561-305-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: