Provider Demographics
NPI:1174923825
Name:GAYNOR, AMBER DAWN
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:GEISSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1779 N CONGRESS AVE # 336
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8205
Mailing Address - Country:US
Mailing Address - Phone:800-686-5614
Mailing Address - Fax:
Practice Address - Street 1:1779 N CONGRESS AVE # 336
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8205
Practice Address - Country:US
Practice Address - Phone:800-686-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst