MEDICARE: MRS. LORI SELWYN 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	SW 5960	FL

General Provider Information

NPI Number	:	1578786455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI SELWYN SMITH LCSW

Provider Business Mailing Address
First Line	:	178 MILEHAM DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-4419
Country	:	US
Telephone Number	:	407-293-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 N PARK AVE
Second Line	:	SUITE 328
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2359
Country	:	US
Telephone Number	:	407-760-7395
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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