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Individual

ALISA AMENDOLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
131 BOSTON POST RD, EAST LYME, CT 06333-1605
(860) 333-5183
Mailing address
PO BOX 848, EAST LYME, CT 06333-0848

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1033666797
CT
Enumeration date
09/21/2022
Last updated
09/21/2022
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