Provider Demographics
NPI:1609236983
Name:PATTERSON, AMY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:15251 SIESTA KEY WAY APT 529
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD STE 320
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6280
Practice Address - Country:US
Practice Address - Phone:301-882-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2020-03-20
Deactivation Date:2020-03-07
Deactivation Code:
Reactivation Date:2020-03-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional