Provider Demographics
NPI:1679814289
Name:BERNARD, AMANDA JANE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JANE
Last Name:BERNARD
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 1:413 BLOOMFIELD AVE
Mailing Address - Street 2:APT C
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3572
Mailing Address - Country:US
Mailing Address - Phone:917-208-3110
Mailing Address - Fax:
Practice Address - Street 1:413 BLOOMFIELD AVE
Practice Address - Street 2:APT C
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3572
Practice Address - Country:US
Practice Address - Phone:917-208-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-11988103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst