Provider Demographics
NPI:1962623025
Name:SMITH, MELODY (LMHC CI)
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W PALMETTO PARK ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-393-1911
Mailing Address - Fax:561-393-9105
Practice Address - Street 1:199 W PALMETTO PARK ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-393-1911
Practice Address - Fax:561-393-9105
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health