Provider Demographics
NPI:1386245124
Name:SMITH, ASHLEY ANN (BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
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 1:14271 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-5509
Mailing Address - Country:US
Mailing Address - Phone:518-319-6116
Mailing Address - Fax:
Practice Address - Street 1:2542 VT ROUTE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT CENTER
Practice Address - State:VT
Practice Address - Zip Code:05857-9712
Practice Address - Country:US
Practice Address - Phone:518-319-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001542103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst