MEDICARE: AMANDA MILLS BCBA

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
1	103K00000X	Behavior Analyst	000915-1	NY

General Provider Information

NPI Number	:	1649767088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MILLS BCBA

Provider Business Mailing Address
First Line	:	1649 61ST ST FL 3013
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1649 61ST ST FL 3013
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2110
Country	:	US
Telephone Number	:	866-222-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	03/11/2025

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