Provider Demographics
NPI:1225500101
Name:SMITH, ANGELA JEAN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 CROMWELL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3318
Mailing Address - Country:US
Mailing Address - Phone:410-853-7044
Mailing Address - Fax:
Practice Address - Street 1:1026 CROMWELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3318
Practice Address - Country:US
Practice Address - Phone:410-853-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-18-31887103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst