Basic Information
| Provider Information | |||||||||
| NPI: | 1821369190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMADEO | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19321 W SAINT ANDREWS DR | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330152337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052151773 | ||||||||
| FaxNumber: | 9545777780 | ||||||||
| Practice Location | |||||||||
| Address1: | 3520 OAKS WAY APT 904 | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058071909 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2012 | ||||||||
| LastUpdateDate: | 11/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | FL | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103K00000X | 1-19-37799 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 261498076 | 01 | FL | PROGRESSIVE BEHAVIORAL SCIENCES | OTHER |