Provider Demographics
NPI:1144717554
Name:SMITH, MARICAR DESIRE (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MARICAR
Middle Name:DESIRE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:MARICAR
Other - Middle Name:DESIRE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:3634 ORCUTT RD
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-2604
Mailing Address - Country:US
Mailing Address - Phone:802-363-6418
Mailing Address - Fax:
Practice Address - Street 1:2400 PROFESSIONAL PKWY STE 150
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1635
Practice Address - Country:US
Practice Address - Phone:805-748-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician