Provider Demographics
NPI:1003373077
Name:SMITH, JANICE (BCBA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
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 1:2146 E NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1621
Mailing Address - Country:US
Mailing Address - Phone:818-960-5512
Mailing Address - Fax:
Practice Address - Street 1:2146 E NEWCASTLE DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-1621
Practice Address - Country:US
Practice Address - Phone:181-896-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-18-9316106E00000X
CA1-21-54584103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0-18-9318OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)
CA1-21-54584OtherBOARD CERTIFIED BEHAVIOR ANALYST