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NPI Code Detail

MEDICARE: MRS. AMBER MENDRES SMITH MA, BCBA

MEDICARE: MRS. AMBER MENDRES SMITH MA, 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
1103K00000XBehavior Analyst1-10-6784MD

General Provider Information

NPI Number : 1801130273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMBER MENDRES SMITH MA, BCBA
Provider Business Mailing Address
First Line : 137 KENTUCKY AVE
Second Line :
City : PASADENA
State : MD
Zip : 21122-5400
Country : US
Telephone Number : 443-305-2276
Fax Number : 443-817-2375
Provider Business Practice Location Address
First Line : 137 KENTUCKY AVE
Second Line :
City : PASADENA
State : MD
Zip : 21122-5400
Country : US
Telephone Number : 443-305-2276
Fax Number : 443-817-2375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2012
Last Update Date : 11/25/2012

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