Provider Demographics
NPI:1245912369
Name:SMITH, MARSHAE' AHJANEE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:MARSHAE'
Middle Name:AHJANEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:MARSHAE
Other - Middle Name:AHJANEE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BEHAVIOR TECHNICIAN
Mailing Address - Street 1:7108 S KANNER HWY, STUART, FL 34997
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3969 BUTTON CREEK CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-3654
Practice Address - Country:US
Practice Address - Phone:702-695-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23-258032106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician