Healthcare Provider Details

I. General information

NPI: 1356669816
Provider Name (Legal Business Name): COLLEEN SMITH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLLEEN STEVENS

II. Dates (important events)

Enumeration Date: 05/08/2010
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 WEST DR
CENTER VALLEY PA
18034-9075
US

IV. Provider business mailing address

3790 WEST DR
CENTER VALLEY PA
18034-9075
US

V. Phone/Fax

Practice location:
  • Phone: 973-768-7195
  • Fax:
Mailing address:
  • Phone: 973-768-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-6626
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: