Healthcare Provider Details

I. General information

NPI: 1942759204
Provider Name (Legal Business Name): VIRGINIA YASMINE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 W COLONIAL DR SUITE 340
WINTER GARDEN FL
34787-3964
US

IV. Provider business mailing address

13130 LAKEWIND DR
CLERMONT FL
34711-5334
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-4433
  • Fax: 407-926-0209
Mailing address:
  • Phone: 352-227-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: