MEDICARE: STEPHANIE SMITH LCSW

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
1	1041C0700X	Clinical Social Worker	14387	FL

General Provider Information

NPI Number	:	1427611847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SMITH LCSW

Provider Business Mailing Address
First Line	:	22573 ESPLANADA DR APT E
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-5929
Country	:	US
Telephone Number	:	530-957-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	7138 LAKE WORTH RD STE D
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2970
Country	:	US
Telephone Number	:	530-957-2828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	04/22/2019

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