MEDICARE: AMALIE JAMES-BIRD BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BH005312	PA

General Provider Information

NPI Number	:	1194583450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMALIE JAMES-BIRD BCBA

Provider Business Mailing Address
First Line	:	53 EAST DR
Second Line	:
City	:	INKERMAN
State	:	PA
Zip	:	18640-2276
Country	:	US
Telephone Number	:	501-606-6839
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 EAST DR
Second Line	:
City	:	INKERMAN
State	:	PA
Zip	:	18640-2276
Country	:	US
Telephone Number	:	501-606-6839
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/12/2024

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