Healthcare Provider Details

I. General information

NPI: 1891459186
Provider Name (Legal Business Name): ANGELIQUE L SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2021
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967 CAMINO DOS ANTONIOS
SANTA FE NM
87507-3307
US

IV. Provider business mailing address

1967 CAMINO DOS ANTONIOS
SANTA FE NM
87507-3307
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-9590
  • Fax:
Mailing address:
  • Phone: 505-780-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: