Provider Demographics
NPI:1326489741
Name:KELLY, AMANDA N (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:N
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59-033 HUELO ST
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9711
Mailing Address - Country:US
Mailing Address - Phone:808-298-2658
Mailing Address - Fax:
Practice Address - Street 1:66-434 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-2414
Practice Address - Country:US
Practice Address - Phone:808-277-7736
Practice Address - Fax:808-748-0202
Is Sole Proprietor?:No
Enumeration Date:2013-07-14
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01-08-4140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst