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NPI Code Detail

MEDICARE: DR. AMANDA KEATING PSYD, BCBA-D

MEDICARE: DR. AMANDA KEATING PSYD, BCBA-D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2103T00000XPsychologistPY8402FL

General Provider Information

NPI Number : 1215363825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA KEATING PSYD, BCBA-D
Provider Business Mailing Address
First Line : 7320 E FLETCHER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33637-0916
Country : US
Telephone Number : 813-490-6365
Fax Number : 813-926-2947
Provider Business Practice Location Address
First Line : 7320 E FLETCHER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33637-0916
Country : US
Telephone Number : 813-490-6365
Fax Number : 813-926-2947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2013
Last Update Date : 09/16/2013

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