Healthcare Provider Details

I. General information

NPI: 1821681040
Provider Name (Legal Business Name): PATRICIA OUTEN SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MICHELANGELO PL
SAINT AUGUSTINE FL
32084-2448
US

IV. Provider business mailing address

261 MICHELANGELO PL
SAINT AUGUSTINE FL
32084-2448
US

V. Phone/Fax

Practice location:
  • Phone: 904-254-6920
  • Fax:
Mailing address:
  • Phone: 904-254-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18138
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200001650
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: