Provider Demographics
NPI:1174988059
Name:DUFFY, AMANDA (MED,BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MED,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4268
Mailing Address - Country:US
Mailing Address - Phone:610-688-8597
Mailing Address - Fax:610-688-8632
Practice Address - Street 1:140 ROCKWOOD RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4268
Practice Address - Country:US
Practice Address - Phone:610-688-8597
Practice Address - Fax:610-688-8632
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-12-12537103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1-12-12537OtherBEHAVIOR ANALYST CERTIFICATION BOARD