Provider Demographics
NPI:1104649284
Name:SMITH, WILLIAM HARRISON III (RBT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRISON
Last Name:SMITH
Suffix:III
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SE 31ST CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2404
Mailing Address - Country:US
Mailing Address - Phone:646-446-0182
Mailing Address - Fax:
Practice Address - Street 1:1600 SE 31ST CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2404
Practice Address - Country:US
Practice Address - Phone:646-446-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1110128106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician