Provider Demographics
NPI:1518384049
Name:SMITH, ALYSSA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:CHOUINARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:51 SPRUCEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-3316
Mailing Address - Country:US
Mailing Address - Phone:203-725-2279
Mailing Address - Fax:
Practice Address - Street 1:51 SPRUCEWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-3316
Practice Address - Country:US
Practice Address - Phone:203-725-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-14-15286103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst