Provider Demographics
NPI:1881992378
Name:AYRES, AMY NICOLE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:AYRES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14638 BOURNEMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3322
Mailing Address - Country:US
Mailing Address - Phone:813-480-7046
Mailing Address - Fax:813-818-1257
Practice Address - Street 1:14638 BOURNEMOUTH RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3322
Practice Address - Country:US
Practice Address - Phone:813-480-7046
Practice Address - Fax:813-818-1257
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3338103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst