Provider Demographics
NPI:1609398924
Name:MCKIERNAN, AMANDA LYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:MCKIERNAN
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 1:105 GARTH RD APT 6G
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3741
Mailing Address - Country:US
Mailing Address - Phone:914-774-7362
Mailing Address - Fax:
Practice Address - Street 1:963 SCARSDALE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4852
Practice Address - Country:US
Practice Address - Phone:914-810-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001555103K00000X
NY1-17-26351103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001555OtherLICENSED BEHAVIOR ANALYST