1174988059 NPI number — AMANDA DUFFY M.ED.,BCBA

Table of content: AMANDA DUFFY M.ED.,BCBA (NPI 1174988059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174988059 NPI number — AMANDA DUFFY M.ED.,BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUFFY
Provider First Name:
AMANDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED.,BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174988059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 ROCKWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19073-4268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-688-8597
Provider Business Mailing Address Fax Number:
610-688-8632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 ROCKWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTOWN SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19073-4268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-688-8597
Provider Business Practice Location Address Fax Number:
610-688-8632
Provider Enumeration Date:
12/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-12-12537 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-12-12537 . This is a "BEHAVIOR ANALYST CERTIFICATION BOARD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com