Provider Demographics
NPI:1104393800
Name:SMITH, MAKAYLA LYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:LYNN
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 ROUTE 101 STE 11
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 ROUTE 101 STE 11
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5031
Practice Address - Country:US
Practice Address - Phone:603-471-2522
Practice Address - Fax:877-754-5246
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-18-31628103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst