Provider Demographics
NPI:1790356897
Name:WEBB, AMBER MADISON (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MADISON
Last Name:WEBB
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MADISON
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2377 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4326
Mailing Address - Country:US
Mailing Address - Phone:904-579-4779
Mailing Address - Fax:
Practice Address - Street 1:2377 MARKET DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4326
Practice Address - Country:US
Practice Address - Phone:904-579-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-24-70562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician