Provider Demographics
NPI:1740643519
Name:LYNCH, AMANDA CAROL (BCBA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CAROL
Last Name:LYNCH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:CAROL
Other - Last Name:PAIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:236 PECAN PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1903
Mailing Address - Country:US
Mailing Address - Phone:925-759-4515
Mailing Address - Fax:
Practice Address - Street 1:236 PECAN PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1903
Practice Address - Country:US
Practice Address - Phone:925-759-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-19127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst