Provider Demographics
NPI:1962941161
Name:CONTRERAS, AMANDA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 COLMAR RD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-7436
Mailing Address - Country:US
Mailing Address - Phone:909-915-9733
Mailing Address - Fax:
Practice Address - Street 1:1664 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-5102
Practice Address - Country:US
Practice Address - Phone:909-915-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-35227103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst