Provider Demographics
NPI:1649778788
Name:FORCZEK, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FORCZEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BURLINGTON MOUNT HOLLY RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4723
Mailing Address - Country:US
Mailing Address - Phone:609-614-7495
Mailing Address - Fax:609-614-7495
Practice Address - Street 1:1900 BURLINGTON MOUNT HOLLY RD STE 2A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4723
Practice Address - Country:US
Practice Address - Phone:609-614-7495
Practice Address - Fax:609-614-7495
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician