Healthcare Provider Details

I. General information

NPI: 1104699552
Provider Name (Legal Business Name): SARAH LOUISE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 VEDDER LN
ORLANDO FL
32832-4996
US

IV. Provider business mailing address

4360 SHORE DR
VIRGINIA BEACH VA
23455-2994
US

V. Phone/Fax

Practice location:
  • Phone: 407-488-0338
  • Fax:
Mailing address:
  • Phone: 757-251-0879
  • Fax: 984-220-9437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: