Provider Demographics
NPI:1154757987
Name:BALAS, AMY L (BCBA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:BALAS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1831 2ND ST NE
Mailing Address - Street 2:APT. 206
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1570
Mailing Address - Country:US
Mailing Address - Phone:703-201-7877
Mailing Address - Fax:
Practice Address - Street 1:1831 2ND ST NE
Practice Address - Street 2:APT. 206
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1570
Practice Address - Country:US
Practice Address - Phone:703-201-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1-13-13765103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst