Provider Demographics
NPI:1124335575
Name:SBLENDORIO, AMY E (MED, CAGS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:SBLENDORIO
Suffix:
Gender:F
Credentials:MED, CAGS, BCBA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:PERMENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CAGS, BCBA
Mailing Address - Street 1:54 DARNELL LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1951
Mailing Address - Country:US
Mailing Address - Phone:134-786-0169
Mailing Address - Fax:
Practice Address - Street 1:54 DARNELL LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1951
Practice Address - Country:US
Practice Address - Phone:134-786-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002417-1101YM0800X
NY1-096406103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst