Provider Demographics
NPI:1043651219
Name:SMITH, COLLEEN ELIZABETH (MSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E ROSE ST
Mailing Address - Street 2:ATTN COLLEEN SMITH
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-2016
Mailing Address - Country:US
Mailing Address - Phone:863-413-2136
Mailing Address - Fax:863-413-3146
Practice Address - Street 1:1010 E ROSE ST
Practice Address - Street 2:ATTN COLLEEN SMITH
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2016
Practice Address - Country:US
Practice Address - Phone:863-413-2136
Practice Address - Fax:863-413-3146
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 8149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker