Provider Demographics
NPI:1437911351
Name:YANG, AMANDA MADISON (RBT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MADISON
Last Name:YANG
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 SAINT NIKOLA CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3592
Mailing Address - Country:US
Mailing Address - Phone:619-847-2613
Mailing Address - Fax:
Practice Address - Street 1:891 SAINT NIKOLA CT
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3592
Practice Address - Country:US
Practice Address - Phone:619-847-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY8495736106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician