Individual
MRS. NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
111 CHARTER OAK AVE, RIVER STREET AUTSIM PROGRAM AT COLTSVILLE, HARTFORD, CT 06106-1912
(860) 298-9079
(860) 722-9438
Mailing address
111 CHARTER OAK AVE, RIVER STREET AUTSIM PROGRAM AT COLTSVILLE, HARTFORD, CT 06106-1912
(860) 298-9079
(860) 722-9438
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-00-0342
CT
Other
Enumeration date
10/26/2011
Last updated
10/26/2011
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