Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-18-29410 | FL |
N | 106E00000X | Assistant Behavior Analyst | 0-16-7061 | FL |
NPI | 1134536790 |
---|---|
Provider Name | Amanda Caroline Chewning |
First Address | Lake Mary, FL 32746 |
Second Address | Mount Dora, FL 32757-6750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 09/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009093700 | (05) | FL |