Provider Demographics
NPI:1164824082
Name:JARMUZ-SMITH, SUSAN (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:JARMUZ-SMITH
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 WASHINGTON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3675
Mailing Address - Country:US
Mailing Address - Phone:207-613-7324
Mailing Address - Fax:207-613-7333
Practice Address - Street 1:1321 WASHINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3675
Practice Address - Country:US
Practice Address - Phone:207-613-7324
Practice Address - Fax:207-613-7333
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1492103TC0700X
BACB238109103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst