Provider Demographics
NPI:1629418991
Name:DAHLIN, AMANDA L (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:DAHLIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:SANTOSSILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 ANGUS ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-4443
Mailing Address - Country:US
Mailing Address - Phone:508-930-4942
Mailing Address - Fax:
Practice Address - Street 1:4 BARLOWS LANDING RD
Practice Address - Street 2:SUITE 13
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1980
Practice Address - Country:US
Practice Address - Phone:508-563-5767
Practice Address - Fax:508-563-5774
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI13902705Medicaid