Provider Demographics
NPI:1366406266
Name:SMITH, PAULA HINTON (ED S)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:HINTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 E HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-6011
Mailing Address - Country:US
Mailing Address - Phone:352-315-7500
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:5633 E HARBOR DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-6011
Practice Address - Country:US
Practice Address - Phone:352-315-7500
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 846103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool