Provider Demographics
NPI:1932646775
Name:SMITH, CHAD RYAN (MA)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:RYAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15643 SHERMAN WAY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4135
Mailing Address - Country:US
Mailing Address - Phone:626-531-6999
Mailing Address - Fax:626-531-6998
Practice Address - Street 1:15643 SHERMAN WAY
Practice Address - Street 2:SUITE 440
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4135
Practice Address - Country:US
Practice Address - Phone:626-531-6999
Practice Address - Fax:626-531-6998
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician