Healthcare Provider Details

I. General information

NPI: 1760990600
Provider Name (Legal Business Name): MARISSA ROSE AMAT-ROGERS MS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA ROSE AMAT MS BCBA

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3243 SAN CARLOS DR
SPRING VALLEY CA
91978-1059
US

IV. Provider business mailing address

3243 SAN CARLOS DR
SPRING VALLEY CA
91978-1059
US

V. Phone/Fax

Practice location:
  • Phone: 619-873-7067
  • Fax: 619-639-8277
Mailing address:
  • Phone: 619-320-5235
  • Fax: 619-599-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: