Healthcare Provider Details

I. General information

NPI: 1639884992
Provider Name (Legal Business Name): JENNIFER SMITH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 GRANITE ST FL 3
MANCHESTER NH
03102-4000
US

IV. Provider business mailing address

42 LAWRENCE ST
CONCORD NH
03301-5313
US

V. Phone/Fax

Practice location:
  • Phone: 603-801-4714
  • Fax:
Mailing address:
  • Phone: 603-491-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: