Healthcare Provider Details

I. General information

NPI: 1447169453
Provider Name (Legal Business Name): AMARIA ANDERSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14055 CEDAR RD FL 3
CLEVELAND OH
44118-3337
US

IV. Provider business mailing address

14055 CEDAR RD FL 3
CLEVELAND OH
44118-3337
US

V. Phone/Fax

Practice location:
  • Phone: 317-721-8884
  • Fax:
Mailing address:
  • Phone: 317-721-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-343148
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: