MEDICARE: DIONNE SMITH

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	101YM0800X	Mental Health Counselor	IMH22796	FL

General Provider Information

NPI Number	:	1457049876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONNE SMITH

Provider Business Mailing Address
First Line	:	1639 FORUM PL STE 7
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1270 W 1ST ST
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-7202
Country	:	US
Telephone Number	:	786-636-4455
Fax Number	:

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

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/25/2023

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Directions to “ DIONNE SMITH ” Practice Location

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