Most Relevant Information
Provider Data
| NPI Number: | 1003330366 |
| Provider Name: | AMANDA BLAKE |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/28/2017 |
| Last Updated: | 07/28/2017 |
Provider Practice Location
51 WATER ST
WATERTOWN
MA
024724611
Practice Location Phone/Fax
| Phone: | 6179237575 |
| Fax: |
Provider Mailing Location
51 WATER ST
WATERTOWN
MA
024724611
Provider Mailing Phone/Fax
| Phone: | 6179237575 |
| Fax: |