Provider Demographics
NPI:1225422553
Name:SARGENT, AMANDA (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:SARGENT
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 1:364 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3742
Mailing Address - Country:US
Mailing Address - Phone:610-291-0074
Mailing Address - Fax:
Practice Address - Street 1:210 BELLEFONTE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2502
Practice Address - Country:US
Practice Address - Phone:302-762-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABACB124609103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst