Provider Demographics
NPI:1538376934
Name:SMITH, NANCY M (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-6459
Mailing Address - Country:US
Mailing Address - Phone:561-744-4934
Mailing Address - Fax:561-743-3329
Practice Address - Street 1:900 S US HIGHWAY 1
Practice Address - Street 2:SUITE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-6459
Practice Address - Country:US
Practice Address - Phone:561-744-4934
Practice Address - Fax:561-743-3329
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00004441041C0700X
FL0000276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1725Medicare ID - Type Unspecified