MEDICARE: SHEENA BROOKE 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	134195	CA
2	1041C0700X	Clinical Social Worker	0904018175	VA
3	1041C0700X	Clinical Social Worker	SW16247	FL
4	1041C0700X	Clinical Social Worker	5030	OK

General Provider Information

NPI Number	:	1780996496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEENA BROOKE SMITH LCSW

Provider Business Mailing Address
First Line	:	6706 CLAIR SHORE DR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3357
Country	:	US
Telephone Number	:	813-610-4730
Fax Number	:

Provider Business Practice Location Address
First Line	:	6706 CLAIR SHORE DR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3357
Country	:	US
Telephone Number	:	813-610-4730
Fax Number	:

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

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	01/08/2026

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