MEDICARE: MS. MAXINE JOY SMITH M.S.

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

General Provider Information

NPI Number	:	1942452685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAXINE JOY SMITH M.S.

Provider Business Mailing Address
First Line	:	1111 HYPOLUXO RD STE 103
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-4271
Country	:	US
Telephone Number	:	561-616-8411
Fax Number	:	561-616-8412

Provider Business Practice Location Address
First Line	:	1111 HYPOLUXO RD STE 103
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-4271
Country	:	US
Telephone Number	:	561-616-8411
Fax Number	:	561-616-8412

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	09/13/2023

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