Provider Demographics
NPI:1306139811
Name:MEHLENBACHER, AMANDA S (MS, BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:MEHLENBACHER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ARLINGTON BLVD
Mailing Address - Street 2:#606
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 ARLINGTON BLVD
Practice Address - Street 2:#606
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3245
Practice Address - Country:US
Practice Address - Phone:617-733-4972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PABH006132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst