MEDICARE: G.SMART BEHAVIORAL SERVICES

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	103K00000X	Behavior Analyst	MH11533	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780120907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G.SMART BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	8526 CATALINA DRIVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1700
Country	:	US
Telephone Number	:	813-690-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	8526 CATALINA DRIVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1700
Country	:	US
Telephone Number	:	813-690-1016
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	MS. GAIL B. SMART
Credential	:	LMHC
Telephone Number	:	813-690-1016

Provider Enumeration Date	:	01/11/2017
Last Update Date	:	01/11/2017

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