Healthcare Provider Details

I. General information

NPI: 1215230792
Provider Name (Legal Business Name): KAREN SMITH RIDLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6214
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-3950
  • Fax: 813-872-2741
Mailing address:
  • Phone: 352-567-0188
  • Fax: 813-355-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: