Individual
AMANDA CONCANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
2336 SE OCEAN BLVD # 167, STUART, FL 34996-3310
(772) 208-0071
(772) 213-9558
Mailing address
1437 DENVER AVE # 157, LOVELAND, CO 80538-5226
(722) 208-0071
(772) 213-9558
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-136150
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108194000
—
FL
Enumeration date
08/31/2021
Last updated
08/31/2021
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