Healthcare Provider Details

I. General information

NPI: 1619839149
Provider Name (Legal Business Name): AMY WOODWARD MA,BCBA,LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 SPRING GARDEN DR
MIDDLETOWN PA
17057-3033
US

IV. Provider business mailing address

236 PLUM ST
ELIZABETHTOWN PA
17022-2742
US

V. Phone/Fax

Practice location:
  • Phone: 717-583-5102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH005009
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: