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General NPI Number Information
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NPI Number | 1316353642
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Entity Type | Individual
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Provider Name | CARISSA A SMITH LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 6847 N 9TH AVE STE A145
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City | PENSACOLA
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State | FL
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Zip | 32504-7396
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Country | US
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Telephone | 813-420-4456
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Fax | 850-595-1400
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Provider Business Mailing Address
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Address Line | 6847 N 9TH AVE STE A145
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City | PENSACOLA
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State | FL
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Zip | 32504-7396
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Country | US
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Telephone | 813-420-4456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW09930761
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW12921
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License Number State | FL
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