Provider Demographics
NPI:1144996380
Name:SMITH, BREANNA LEIGH (RBT)
Entity type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 ESCAMBIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3626
Mailing Address - Country:US
Mailing Address - Phone:321-446-2071
Mailing Address - Fax:
Practice Address - Street 1:518 ESCAMBIA ST
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3626
Practice Address - Country:US
Practice Address - Phone:321-446-2071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-07773103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst