Provider Demographics
NPI:1194357632
Name:KEM, AMANDA TARADY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:TARADY
Last Name:KEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BARRY RD APT 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-4226
Mailing Address - Country:US
Mailing Address - Phone:401-648-1863
Mailing Address - Fax:
Practice Address - Street 1:7 BARRY RD APT 3
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-4226
Practice Address - Country:US
Practice Address - Phone:401-648-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician