Provider Demographics
NPI:1598073678
Name:CAVENEY, AMY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CAVENEY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28991 OLD TOWN FRONT ST
Mailing Address - Street 2:STE 208
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5803
Mailing Address - Country:US
Mailing Address - Phone:951-699-8640
Mailing Address - Fax:951-699-8650
Practice Address - Street 1:28991 OLD TOWN FRONT ST
Practice Address - Street 2:STE 208
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5803
Practice Address - Country:US
Practice Address - Phone:951-699-8640
Practice Address - Fax:951-699-8650
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-5939103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst