Provider Demographics
NPI:1255920906
Name:SMITH BROWN, JASMINE (BCBA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SMITH BROWN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 STIRLING RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5797
Mailing Address - Country:US
Mailing Address - Phone:908-490-0100
Mailing Address - Fax:
Practice Address - Street 1:76 STIRLING RD STE 105
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5797
Practice Address - Country:US
Practice Address - Phone:908-490-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12041758103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst