Provider Demographics
NPI:1659026144
Name:WINCHESTER, AMANDA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:WINCHESTER
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 1:67 JACKS LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-6152
Mailing Address - Country:US
Mailing Address - Phone:606-425-4371
Mailing Address - Fax:
Practice Address - Street 1:67 JACKS LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6152
Practice Address - Country:US
Practice Address - Phone:606-425-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273757103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY273757OtherKY ABA LICENSE