Provider Demographics
NPI:1902114564
Name:SMITH, DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SHERBERT RD
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1014
Mailing Address - Country:US
Mailing Address - Phone:978-337-7827
Mailing Address - Fax:
Practice Address - Street 1:153 SHERBERT RD
Practice Address - Street 2:
Practice Address - City:ASHBURNHAM
Practice Address - State:MA
Practice Address - Zip Code:01430-1014
Practice Address - Country:US
Practice Address - Phone:978-337-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-08-4036261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA103TB0200XOtherBOARD CERTIFIED BEHAVIOR ANALYST