Provider Demographics
NPI:1972938017
Name:SMITH, ELIZABETH CLOSIUS (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLOSIUS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STONY HILL RD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1166
Mailing Address - Country:US
Mailing Address - Phone:203-648-2470
Mailing Address - Fax:
Practice Address - Street 1:24 STONY HILL RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1166
Practice Address - Country:US
Practice Address - Phone:203-648-2470
Practice Address - Fax:203-826-2256
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-13-14094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst