Provider Demographics
NPI:1255953295
Name:RIVKIN, AMANDA KAYLA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYLA
Last Name:RIVKIN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1036
Mailing Address - Country:US
Mailing Address - Phone:239-932-2220
Mailing Address - Fax:
Practice Address - Street 1:4150 FORD ST STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9498
Practice Address - Country:US
Practice Address - Phone:239-291-5088
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-73569103K00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician