Provider Demographics
NPI:1851681514
Name:DIMMICK, AMY A (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:DIMMICK
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 1:1021 W COMMODORE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5372
Mailing Address - Country:US
Mailing Address - Phone:732-780-2799
Mailing Address - Fax:732-780-2899
Practice Address - Street 1:1021 W COMMODORE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5372
Practice Address - Country:US
Practice Address - Phone:732-780-2799
Practice Address - Fax:732-780-2899
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-16-23949103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst