Provider Demographics
NPI:1861765422
Name:MAO, AMY BETH (BCBA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:MAO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14148 MAGNOLIA BOULEVARD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423
Mailing Address - Country:US
Mailing Address - Phone:818-933-3700
Mailing Address - Fax:805-583-8064
Practice Address - Street 1:14148 MAGNOLIA BOULEVARD
Practice Address - Street 2:SUITE 103
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423
Practice Address - Country:US
Practice Address - Phone:818-933-3700
Practice Address - Fax:805-583-8064
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
CA1-14-16121103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst