Healthcare Provider Details

I. General information

NPI: 1619289287
Provider Name (Legal Business Name): CHERROLYLN C SMITH, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 HIGHLAND MANOR DR SUITE 200
TAMPA FL
33610-9713
US

IV. Provider business mailing address

PO BOX 2288
BRANDON FL
33509-2288
US

V. Phone/Fax

Practice location:
  • Phone: 813-657-0488
  • Fax: 813-657-0488
Mailing address:
  • Phone: 813-657-0488
  • Fax: 813-657-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 6991
License Number StateFL

VIII. Authorized Official

Name: DR. CHERROLYN C SMITH
Title or Position: OWNER
Credential: PHD
Phone: 813-657-0488