Provider Demographics
NPI:1215464870
Name:IGLESIAS, AMANDA DARLENE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DARLENE
Last Name:IGLESIAS
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 1:10151 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4932
Mailing Address - Country:US
Mailing Address - Phone:954-801-3483
Mailing Address - Fax:
Practice Address - Street 1:10151 SW 52ND ST
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-4932
Practice Address - Country:US
Practice Address - Phone:954-801-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician