Provider Demographics
NPI:1821854985
Name:DEFUSCO, AMY-LEE TEDESCO (BCBA, ECSE)
Entity Type:Individual
Prefix:
First Name:AMY-LEE
Middle Name:TEDESCO
Last Name:DEFUSCO
Suffix:
Gender:F
Credentials:BCBA, ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 S HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1166
Mailing Address - Country:US
Mailing Address - Phone:720-690-3199
Mailing Address - Fax:
Practice Address - Street 1:231 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1166
Practice Address - Country:US
Practice Address - Phone:720-690-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-55864103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst