Provider Demographics
NPI:1225912587
Name:LAURITA, AMADA (RBT)
Entity type:Individual
Prefix:
First Name:AMADA
Middle Name:
Last Name:LAURITA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:DESTEHROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1067 E 9TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1561
Mailing Address - Country:US
Mailing Address - Phone:303-845-2057
Mailing Address - Fax:
Practice Address - Street 1:1067 E 9TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1561
Practice Address - Country:US
Practice Address - Phone:303-845-2057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician