Provider Demographics
NPI:1699077503
Name:SMITH, JAMIE M (BCBA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7862 RED MAHOGANY RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7530
Mailing Address - Country:US
Mailing Address - Phone:561-336-0358
Mailing Address - Fax:561-424-8109
Practice Address - Street 1:7862 RED MAHOGANY RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-7530
Practice Address - Country:US
Practice Address - Phone:561-336-0358
Practice Address - Fax:561-424-8109
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X
1-16-21808103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty