Provider Demographics
NPI:1073294005
Name:SMITH, LARRY JERMAINE (LCSW, LMSW)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JERMAINE
Last Name:SMITH
Suffix:
Gender:
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19103 CELLINI PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9009
Mailing Address - Country:US
Mailing Address - Phone:813-272-1954
Mailing Address - Fax:
Practice Address - Street 1:7821 N DALE MABRY HWY STE 208
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3200
Practice Address - Country:US
Practice Address - Phone:813-443-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75851041C0700X
FL186281041C0700X
FLSW244981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical