Provider Demographics
NPI:1154762995
Name:CONNELLY, AMANDA (BCABA)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 SOUTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8396
Mailing Address - Country:US
Mailing Address - Phone:404-735-5506
Mailing Address - Fax:
Practice Address - Street 1:16414 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8396
Practice Address - Country:US
Practice Address - Phone:317-815-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst