Provider Demographics
NPI:1689236820
Name:DESJARDINS, AMELIA BEATRICE (BCBA)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:BEATRICE
Last Name:DESJARDINS
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 1:2 MARY E. CLARK DR. STE 5
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841
Mailing Address - Country:US
Mailing Address - Phone:603-892-3134
Mailing Address - Fax:603-489-1468
Practice Address - Street 1:2 MARY E. CLARK DR. STE 5
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841
Practice Address - Country:US
Practice Address - Phone:603-892-3134
Practice Address - Fax:603-489-1468
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2023-02-06
Deactivation Date:2021-04-27
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NH1-21-49462103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician