Provider Demographics
NPI:1912684010
Name:SMITH, KERIANNA L (ABA)
Entity Type:Individual
Prefix:MS
First Name:KERIANNA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:ABA
Other - Prefix:MS
Other - First Name:KERIANNA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1919 MARKET ST UNIT 332
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2763
Mailing Address - Country:US
Mailing Address - Phone:510-290-0548
Mailing Address - Fax:
Practice Address - Street 1:1919 MARKET ST UNIT 332
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2763
Practice Address - Country:US
Practice Address - Phone:510-290-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician