Provider Demographics
NPI:1255871695
Name:FRUSCO, AMANDA (RBT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FRUSCO
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 W PRICE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-4928
Mailing Address - Country:US
Mailing Address - Phone:908-581-2061
Mailing Address - Fax:
Practice Address - Street 1:4535 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2930
Practice Address - Country:US
Practice Address - Phone:941-883-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
FLRBT-25-42082106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional