Provider Demographics
NPI:1922752740
Name:FIROOZI, AMANDA
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:FIROOZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 SW 43RD DR APT 164B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4108
Mailing Address - Country:US
Mailing Address - Phone:305-833-5100
Mailing Address - Fax:
Practice Address - Street 1:12830 SW 43RD DR APT 164B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4108
Practice Address - Country:US
Practice Address - Phone:305-833-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-191794106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician