Provider Demographics
NPI:1730604430
Name:SMITH, LIZBETH MARTINEZ (BCBA)
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:MARTINEZ
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 1:855 BRADLEY ST NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2979
Mailing Address - Country:US
Mailing Address - Phone:864-547-0735
Mailing Address - Fax:
Practice Address - Street 1:855 BRADLEY ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2979
Practice Address - Country:US
Practice Address - Phone:980-202-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty