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NPI Code Detail

MEDICARE: MS. COLLEEN ELIZABETH SMITH MSW

MEDICARE: MS. COLLEEN ELIZABETH SMITH MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerISW 8149FL

General Provider Information

NPI Number : 1043651219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COLLEEN ELIZABETH SMITH MSW
Provider Business Mailing Address
First Line : 1010 E ROSE ST
Second Line : ATTN COLLEEN SMITH
City : LAKELAND
State : FL
Zip : 33801-2016
Country : US
Telephone Number : 863-413-2136
Fax Number : 863-413-3146
Provider Business Practice Location Address
First Line : 1010 E ROSE ST
Second Line : ATTN COLLEEN SMITH
City : LAKELAND
State : FL
Zip : 33801-2016
Country : US
Telephone Number : 863-413-2136
Fax Number : 863-413-3146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2013
Last Update Date : 07/16/2013

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