Provider Demographics
NPI:1518545367
Name:DIEHL, AMY ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:DIEHL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-1134
Mailing Address - Country:US
Mailing Address - Phone:703-297-7590
Mailing Address - Fax:
Practice Address - Street 1:11480 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5265
Practice Address - Country:US
Practice Address - Phone:202-420-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst