Provider Demographics
NPI:1952044224
Name:CAMMACK, ANGELA AMANDA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:AMANDA
Last Name:CAMMACK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 DOUGLAS ROAD
Mailing Address - Street 2:230
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:844-244-1818
Mailing Address - Fax:888-512-0733
Practice Address - Street 1:9140 GUILFORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1811
Practice Address - Country:US
Practice Address - Phone:410-888-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-22-209782106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician