| Entity Name: | DEBORAH SMITH LCSW PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 23 Jun 2009 (16 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P09000054286 |
| Address: | 6710 EMBASSY BLVD., SUITE 202, PORT RICHEY, FL, 34668, US |
| Mail Address: | 4142 MARINER BLVD., #208, SPRINGHILL, FL, 34609, US |
| ZIP code: | 34668 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407083702 | 2009-06-15 | 2010-08-27 | 7617 CITA LN UNIT 102, MAIL STATION 2, BOX 11, NEW PORT RICHEY, FL, 346536216, US | 7617 CITA LN UNIT 102, MAIL STATION 2, BOX 11, NEW PORT RICHEY, FL, 346536216, US | |||||||||||||||||||||
|
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| Phone | +1 727-232-1689 |
| Fax | 8665958350 |
Authorized person
| Name | DEBORAH SMITH |
| Role | OWNER |
| Phone | 7272321689 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 768390100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH DEBORAH | Agent | 4142 MARINER BLVD, SPRINGHILL, FL, 34609 |
| Name | Role | Address |
|---|---|---|
| SMITH DEBORAH | President | 4142 MARINER BLVD #208, SPRINGHILL, FL, 34609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2009-06-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
