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General NPI Number Information
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NPI Number | 1275915290
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Entity Type | Individual
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Provider Name | AMANDA JANETTE ORTIZ BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 60 GAYWOOD AVE
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City | COLONIA
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State | NJ
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Zip | 07067-2020
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Country | US
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Telephone | 973-902-1495
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Fax |
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Provider Business Mailing Address
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Address Line | 60 GAYWOOD AVE
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City | COLONIA
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State | NJ
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Zip | 07067-2020
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Country | US
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Telephone | 973-902-1495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-53802
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License Number State | NJ
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