Provider Demographics
NPI:1609314228
Name:SMITH, JAMIE ROSHONNDA
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROSHONNDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 HUNTINGTON AVE
Mailing Address - Street 2:#3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6200
Mailing Address - Country:US
Mailing Address - Phone:603-714-2455
Mailing Address - Fax:
Practice Address - Street 1:1400 CINDER ROCK DR
Practice Address - Street 2:202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3984
Practice Address - Country:US
Practice Address - Phone:951-250-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty