MEDICARE: ANGELIQUE L SMITH

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1891459186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE L SMITH

Provider Business Mailing Address
First Line	:	1967 CAMINO DOS ANTONIOS
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3307
Country	:	US
Telephone Number	:	505-780-9590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1967 CAMINO DOS ANTONIOS
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3307
Country	:	US
Telephone Number	:	505-780-9590
Fax Number	:

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

Provider Enumeration Date	:	10/24/2021
Last Update Date	:	04/08/2026

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Directions to “ ANGELIQUE L SMITH ” Practice Location

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