Individual
AMANDA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
706 W PATRICK ST, FREDERICK, MD 21701-4030
(301) 882-7932
Mailing address
706 W PATRICK ST, FREDERICK, MD 21701-4030
(301) 882-7932
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811213507
OTHER
MD
Enumeration date
10/21/2024
Last updated
10/21/2024
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