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General NPI Number Information
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NPI Number | 1992106298
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Entity Type | Individual
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Provider Name | KATHLEEN SMOTHERMAN
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Gender | Female
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Dates
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Enumeration Date | 09/06/2014
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Last Update Date | 09/06/2014
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Provider Practice Location Address
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Address Line | 1955 US 1 S C-2
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3708
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Country | US
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Telephone | 904-209-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 1955 US 1 S C-2
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3708
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Country | US
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Telephone | 904-209-6215
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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 | SW12211
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License Number State | FL
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