MEDICARE: MS. SUYAPA CONCEPCION AMAYA MSW., BCBA, LABA

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	1-16-21868	FL
2	1041C0700X	Clinical Social Worker	6801094246	MI

General Provider Information

NPI Number	:	1265786149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUYAPA CONCEPCION AMAYA MSW., BCBA, LABA

Provider Business Mailing Address
First Line	:	542 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 METROCENTER BLVD STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-7642
Country	:	US
Telephone Number	:	877-999-0258
Fax Number	:

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

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	10/28/2024

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