Provider Demographics
NPI:1548024516
Name:SMITH, MARY KRISTIN (RBT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KRISTIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3050
Mailing Address - Country:US
Mailing Address - Phone:727-480-3539
Mailing Address - Fax:
Practice Address - Street 1:6650 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2940
Practice Address - Country:US
Practice Address - Phone:727-428-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician