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NPI Code Detail

MEDICARE: CARLI SHERIDAN SMITH

MEDICARE: CARLI SHERIDAN SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2106E00000XAssistant Behavior Analyst7402000075MI

General Provider Information

NPI Number : 1811446081
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLI SHERIDAN SMITH
Provider Business Mailing Address
First Line : 28241 MOUND RD
Second Line :
City : WARREN
State : MI
Zip : 48092-5523
Country : US
Telephone Number : 989-401-2244
Fax Number :
Provider Business Practice Location Address
First Line : 28241 MOUND RD
Second Line :
City : WARREN
State : MI
Zip : 48092-5523
Country : US
Telephone Number : 989-401-2244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2016
Last Update Date : 03/17/2026

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Directions to “ CARLI SHERIDAN SMITH ” Practice Location

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