Provider Demographics
NPI:1891505970
Name:SMIGLEWSKI, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SMIGLEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 SE 15TH CT APT 304
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7356
Mailing Address - Country:US
Mailing Address - Phone:646-320-4847
Mailing Address - Fax:
Practice Address - Street 1:1511 SE 15TH CT APT 304
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7356
Practice Address - Country:US
Practice Address - Phone:646-320-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst