Provider Demographics
NPI:1912373838
Name:HARE, AMANDA JOY (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:HARE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:CRUMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 SYLVAN AVE STE 1110
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3118
Mailing Address - Country:US
Mailing Address - Phone:646-873-6600
Mailing Address - Fax:646-859-4440
Practice Address - Street 1:560 SYLVAN AVE STE 1110
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3118
Practice Address - Country:US
Practice Address - Phone:646-873-6600
Practice Address - Fax:646-859-4440
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TN1-21-54520103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker