Provider Demographics
NPI:1083926182
Name:DAVIDSON, AMANDA RUTH (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RUTH
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:RUTH
Other - Last Name:GISBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:155 BARTRAM MARKET DR STE 135-286
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4581
Mailing Address - Country:US
Mailing Address - Phone:904-827-3886
Mailing Address - Fax:844-380-4778
Practice Address - Street 1:101 MARKETSIDE AVE STE 404-411
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-1541
Practice Address - Country:US
Practice Address - Phone:904-827-3886
Practice Address - Fax:904-212-0593
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-09-6647103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst