Provider Demographics
NPI:1881083582
Name:AMADOR, CONNIE M
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:AMADOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 W 73RD TERRACE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5377
Mailing Address - Country:US
Mailing Address - Phone:305-213-7176
Mailing Address - Fax:
Practice Address - Street 1:2881 W 73RD TERRACE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5377
Practice Address - Country:US
Practice Address - Phone:305-213-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst