Provider Demographics
NPI:1730614553
Name:SMITH, THOMAS E (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 AVONDALE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8453
Mailing Address - Country:US
Mailing Address - Phone:850-321-9661
Mailing Address - Fax:
Practice Address - Street 1:2940 E PARK AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3446
Practice Address - Country:US
Practice Address - Phone:850-692-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW143891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical