Provider Demographics
NPI:1417605635
Name:WINTER, AMBER (BCBA,MA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:BCBA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17203 VENTURA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4055
Mailing Address - Country:US
Mailing Address - Phone:818-501-3615
Mailing Address - Fax:818-501-3649
Practice Address - Street 1:12660 RIVERSIDE DR STE 305
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3431
Practice Address - Country:US
Practice Address - Phone:818-614-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-58486103K00000X
CA1-21-58486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-21-58486OtherBCBA