Provider Demographics
NPI:1497096572
Name:JAKUBOWICZ, AMANDA JOSEPHINE (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JOSEPHINE
Last Name:JAKUBOWICZ
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 1:203 S ELMER AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2019
Mailing Address - Country:US
Mailing Address - Phone:607-329-1235
Mailing Address - Fax:607-535-2666
Practice Address - Street 1:203 S ELMER AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2019
Practice Address - Country:US
Practice Address - Phone:607-329-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2021-08-24
Deactivation Date:2021-07-19
Deactivation Code:
Reactivation Date:2021-08-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician