Provider Demographics
NPI:1144729328
Name:SMITH, BENJAMIN ANDREW (BCBA)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 CENTER AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3091
Mailing Address - Country:US
Mailing Address - Phone:714-372-2247
Mailing Address - Fax:805-456-0666
Practice Address - Street 1:7755 CENTER AVE STE 1100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3091
Practice Address - Country:US
Practice Address - Phone:714-372-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst