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General NPI Number Information
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NPI Number | 1679622252
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Entity Type | Individual
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Provider Name | MR. SMITH MITHOU DESRAVINES
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3535 LAWTON RD
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City | ORLANDO
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State | FL
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Zip | 32803-3743
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Country | US
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Telephone | 407-895-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 816 ORIENTA AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5662
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Country | US
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Telephone | 407-268-9245
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Fax | 407-324-7121
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | FL
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