Provider Demographics
NPI:1720343221
Name:GUIGNARD, AMANDA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GUIGNARD
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:25 ST ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1227
Mailing Address - Country:US
Mailing Address - Phone:917-837-9677
Mailing Address - Fax:
Practice Address - Street 1:25 ST ANDREWS DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1227
Practice Address - Country:US
Practice Address - Phone:917-837-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
NY1-14-10422103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst