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General NPI Number Information
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NPI Number | 1730614553
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Entity Type | Individual
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Provider Name | THOMAS E SMITH PHD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2017
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Last Update Date | 04/30/2017
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Provider Practice Location Address
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Address Line | 2940 E PARK AVE SUITE 1A
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City | TALLAHASSEE
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State | FL
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Zip | 32301-3446
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Country | US
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Telephone | 850-692-6540
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 AVONDALE WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32317-8453
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Country | US
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Telephone | 850-321-9661
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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 | SW14389
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License Number State | FL
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