Provider Demographics
NPI:1962046003
Name:BURRELL, AMARI N
Entity Type:Individual
Prefix:MS
First Name:AMARI
Middle Name:N
Last Name:BURRELL
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 1:2258 SALVADOR ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-5311
Mailing Address - Country:US
Mailing Address - Phone:606-748-5848
Mailing Address - Fax:
Practice Address - Street 1:ST. ALOYCIUS ORPHANAGE 4721 READING RD.
Practice Address - Street 2:4721 READING ROAD
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-4523
Practice Address - Country:US
Practice Address - Phone:513-748-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYB11-190-394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst