Individual
AMY R BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
84 ROUTE 59 STE 102, SUFFERN, NY 10901-4910
(718) 650-6540
Mailing address
84 ROUTE 59 STE 102, SUFFERN, NY 10901-4910
(718) 650-6540
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-19041
BACB
—
Enumeration date
11/19/2018
Last updated
11/19/2018
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