Provider Demographics
NPI:1073066114
Name:SMITH, ANTOINETTE MARIE (BA,AA)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA,AA
Other - Prefix:MS
Other - First Name:ANTOINETTE
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1299 ZEPOL RD
Mailing Address - Street 2:UNIT 80
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3090
Mailing Address - Country:US
Mailing Address - Phone:505-920-6999
Mailing Address - Fax:
Practice Address - Street 1:2960 RODEO PARK DR W
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6351
Practice Address - Country:US
Practice Address - Phone:505-986-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst