Provider Demographics
NPI:1235676701
Name:MANNING, AMANDA (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CATEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LBA
Mailing Address - Street 1:PO BOX 412031
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2031
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:1161 E CLARK RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-7930
Practice Address - Country:US
Practice Address - Phone:517-507-5565
Practice Address - Fax:517-481-2198
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-18-33240103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst