Provider Demographics
NPI:1265995211
Name:NEAL, AMY (PHD, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:PHD, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BUCCANEER CT APT 2
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5001
Mailing Address - Country:US
Mailing Address - Phone:804-337-7640
Mailing Address - Fax:
Practice Address - Street 1:500 W JUBAL EARLY DR STE 210
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6508
Practice Address - Country:US
Practice Address - Phone:540-431-5641
Practice Address - Fax:540-431-5628
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst