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General NPI Number Information
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NPI Number | 1477833713
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Entity Type | Individual
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Provider Name | MATTHEW SMITH MA
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Gender | Male
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 235 S MAITLAND AVE STE 113
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City | MAITLAND
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State | FL
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Zip | 32751-5629
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Country | US
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Telephone | 321-578-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 409 PARSON BROWN WAY
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City | LONGWOOD
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State | FL
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Zip | 32750-4020
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Country | US
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Telephone | 407-415-7701
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13072
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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