Provider Demographics
NPI:1316218886
Name:SMITH, SARAH J (BCBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4056
Mailing Address - Country:US
Mailing Address - Phone:270-444-9687
Mailing Address - Fax:270-444-8105
Practice Address - Street 1:801 N 29TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4056
Practice Address - Country:US
Practice Address - Phone:270-444-9687
Practice Address - Fax:270-444-8105
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244518103K00000X
261QM0801X
KY1-18-30854103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)