Provider Demographics
NPI:1588086151
Name:GREGORIO, AMANDA (MSED, BCBA)
Entity type:Individual
Prefix:MR
First Name:AMANDA
Middle Name:
Last Name:GREGORIO
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OVERLEA LN
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2108
Mailing Address - Country:US
Mailing Address - Phone:347-782-8083
Mailing Address - Fax:
Practice Address - Street 1:5 OVERLEA LN
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2108
Practice Address - Country:US
Practice Address - Phone:347-782-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
1-17-26606103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist