Provider Demographics
NPI:1164205910
Name:LAPOLT, AMBER JAYD (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JAYD
Last Name:LAPOLT
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 STATE ROUTE 52 APT 4
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-8329
Mailing Address - Country:US
Mailing Address - Phone:845-554-6802
Mailing Address - Fax:
Practice Address - Street 1:1428 STATE ROUTE 52 APT 4
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8329
Practice Address - Country:US
Practice Address - Phone:845-554-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002998103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst