MEDICARE: ASHLEY ANN SMITH BCBA

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
1	103K00000X	Behavior Analyst	001542	NY

General Provider Information

NPI Number	:	1386245124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ANN SMITH BCBA

Provider Business Mailing Address
First Line	:	14271 STATE ROUTE 30
Second Line	:
City	:	MALONE
State	:	NY
Zip	:	12953-5509
Country	:	US
Telephone Number	:	518-319-6116
Fax Number	:

Provider Business Practice Location Address
First Line	:	2542 VT ROUTE 105
Second Line	:
City	:	NEWPORT CENTER
State	:	VT
Zip	:	05857-9712
Country	:	US
Telephone Number	:	518-319-6116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	11/06/2020

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