Provider Demographics
NPI:1700472206
Name:AMADOR, SANDY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:AMADOR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 THAMES AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-2983
Mailing Address - Country:US
Mailing Address - Phone:765-357-1449
Mailing Address - Fax:855-940-0177
Practice Address - Street 1:2785 CASON ST # 2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2843
Practice Address - Country:US
Practice Address - Phone:765-446-4185
Practice Address - Fax:765-448-1864
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-23-64800103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst