Provider Demographics
NPI:1003213133
Name:LIPINSKI, AMANDA (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LIPINSKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 UNIVERSITY AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4612
Mailing Address - Country:US
Mailing Address - Phone:201-456-3296
Mailing Address - Fax:
Practice Address - Street 1:328 ULUNIU ST
Practice Address - Street 2:STE. 201
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2547
Practice Address - Country:US
Practice Address - Phone:808-263-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-14-9668103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst