Provider Demographics
NPI:1821839655
Name:RIZZO, AMANDA DAWN (M ED , BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:RIZZO
Suffix:
Gender:F
Credentials:M ED , BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 CH SLATON RD
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-7055
Mailing Address - Country:US
Mailing Address - Phone:912-326-1845
Mailing Address - Fax:
Practice Address - Street 1:223 CH SLATON RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7055
Practice Address - Country:US
Practice Address - Phone:912-326-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst