Provider Demographics
NPI:1912616483
Name:BAGNELL, AMANDA M (BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:BAGNELL
Suffix:
Gender:F
Credentials:BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N MAIN ST APT 26
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2905
Mailing Address - Country:US
Mailing Address - Phone:215-588-5607
Mailing Address - Fax:
Practice Address - Street 1:131 N MAIN ST APT 26
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2905
Practice Address - Country:US
Practice Address - Phone:215-588-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-61237103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst