Provider Demographics
NPI:1962759373
Name:BAMFORD, DANA MARIE (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:BAMFORD
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:SWARTZWELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/BCBA
Mailing Address - Street 1:1920 BRIARCLIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4010
Mailing Address - Country:US
Mailing Address - Phone:404-785-9462
Mailing Address - Fax:404-785-9055
Practice Address - Street 1:1920 BRIARCLIFF RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4010
Practice Address - Country:US
Practice Address - Phone:404-785-9462
Practice Address - Fax:404-785-9055
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-11-9337103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst