Provider Demographics
NPI:1255803516
Name:ARTEAGA, AMY JENAVIE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JENAVIE
Last Name:ARTEAGA
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 1:858 HUNTINGTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6200
Mailing Address - Country:US
Mailing Address - Phone:951-837-8588
Mailing Address - Fax:
Practice Address - Street 1:858 HUNTINGTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6200
Practice Address - Country:US
Practice Address - Phone:951-837-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-70585106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician