Individual
TEYANA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
74 FAIRVIEW ST, PROVIDENCE, RI 02908-4423
(401) 559-3672
Mailing address
74 FAIRVIEW ST, PROVIDENCE, RI 02908-4423
(401) 559-3672
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R59913317
BLUECROSS BLUESHIELD
RI
Enumeration date
09/09/2021
Last updated
09/09/2021
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