Provider Demographics
NPI:1932965431
Name:SMITH, TYLER ALAN (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BENEFIT ST APT 19
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-6715
Mailing Address - Country:US
Mailing Address - Phone:860-481-0793
Mailing Address - Fax:
Practice Address - Street 1:45 SOCKANOSSET CROSS RD # 100
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5529
Practice Address - Country:US
Practice Address - Phone:401-409-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILBA00267103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst