Provider Demographics
NPI:1801130273
Name:SMITH, AMBER MENDRES (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MENDRES
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:ELIZABETH
Other - Last Name:MENDRES-SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:137 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5400
Mailing Address - Country:US
Mailing Address - Phone:443-305-2276
Mailing Address - Fax:443-817-2375
Practice Address - Street 1:137 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-5400
Practice Address - Country:US
Practice Address - Phone:443-305-2276
Practice Address - Fax:443-817-2375
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-10-6784103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst