Provider Demographics
NPI:1831606763
Name:BAYER, AMY KATHLEEN (MA BCBA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:KATHLEEN
Last Name:BAYER
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 1:35 BUTLER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3909
Mailing Address - Country:US
Mailing Address - Phone:401-489-5729
Mailing Address - Fax:
Practice Address - Street 1:35 BUTLER ST APT 2
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3909
Practice Address - Country:US
Practice Address - Phone:401-489-5729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRBT-16-26585106S00000X
RI1-17-29057103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician