Provider Demographics
NPI:1134536790
Name:EMRICK, AMANDA CAROLINE (BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROLINE
Last Name:EMRICK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CAROLINE
Other - Last Name:KASPAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:383 FOXHILL DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-4526
Mailing Address - Country:US
Mailing Address - Phone:352-256-8240
Mailing Address - Fax:
Practice Address - Street 1:324 NEWBURYPORT AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3645
Practice Address - Country:US
Practice Address - Phone:352-256-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-16-7061106E00000X
FL1-18-29410103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009093700Medicaid