Provider Demographics
NPI:1073066114
Name:SMITH, ANTOINETTE MARIE (BA,AA)
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA,AA
Other - Prefix:MS
Other - First Name:ANTOINETTE
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1299 ZEPOL RD
Mailing Address - Street 2:UNIT 80
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3090
Mailing Address - Country:US
Mailing Address - Phone:505-920-6999
Mailing Address - Fax:
Practice Address - Street 1:1709 MOON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3935
Practice Address - Country:US
Practice Address - Phone:505-271-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst