Healthcare Provider Details

I. General information

NPI: 1598171217
Provider Name (Legal Business Name): AMANDA URBELIS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS AMANDA MASON

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CLYDE RD STE 201
SOMERSET NJ
08873-5038
US

IV. Provider business mailing address

25 CLYDE RD STE 201
SOMERSET NJ
08873-5038
US

V. Phone/Fax

Practice location:
  • Phone: 908-917-2552
  • Fax:
Mailing address:
  • Phone: 908-917-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16137
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: