Provider Demographics
NPI:1386194702
Name:BREWER, AMANDA LOUISE (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUISE
Last Name:BREWER
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 1:23241 S POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1413
Mailing Address - Country:US
Mailing Address - Phone:949-315-5070
Mailing Address - Fax:949-457-9213
Practice Address - Street 1:23241 S POINTE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1413
Practice Address - Country:US
Practice Address - Phone:949-315-5070
Practice Address - Fax:949-457-9213
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-23079103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst