Provider Demographics
NPI:1992097158
Name:SMITH, ROHAN (MSW)
Entity type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N STATE ROAD 7
Mailing Address - Street 2:SUITE 209-4
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4804
Mailing Address - Country:US
Mailing Address - Phone:954-980-8241
Mailing Address - Fax:
Practice Address - Street 1:4000 N STATE ROAD 7
Practice Address - Street 2:SUITE 209-4
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4804
Practice Address - Country:US
Practice Address - Phone:954-980-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator