Healthcare Provider Details

I. General information

NPI: 1396265195
Provider Name (Legal Business Name): HALLIE MARIE SMITH PHD, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205
US

IV. Provider business mailing address

1443 ROLAND HEIGHTS AVE
BALTIMORE MD
21211-1212
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-2976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number261027
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06072
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: