Basic Information
| Provider Information | |||||||||
| NPI: | 1235873266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLOMON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS ABA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 REGIONAL DR STE 7 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033018518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032247630 | ||||||||
| FaxNumber: | 6034101105 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 REGIONAL DR STE 7 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033018518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032247630 | ||||||||
| FaxNumber: | 6034101105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2022 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-21-48793 | NH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.