Basic Information
| Provider Information | |||||||||
| NPI: | 1326489741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, BCBA-D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59-033 HUELO ST | ||||||||
| Address2: | |||||||||
| City: | HALEIWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967129711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082982658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 66-434 KAMEHAMEHA HWY | ||||||||
| Address2: | |||||||||
| City: | HALEIWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967122414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082777736 | ||||||||
| FaxNumber: | 8087480202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2013 | ||||||||
| LastUpdateDate: | 07/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 01-08-4140 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.