Provider Demographics
NPI:1649974361
Name:SMITH, ADELINE
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 APOPKA RESERVE LN APT 312
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-8352
Mailing Address - Country:US
Mailing Address - Phone:346-604-4608
Mailing Address - Fax:
Practice Address - Street 1:1329 WINTER GARDEN VINELAND RD STE 110
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4353
Practice Address - Country:US
Practice Address - Phone:346-604-4608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-259116106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician