Provider Demographics
NPI:1235931130
Name:LAURITO, AMANDA (LBS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:LAURITO
Suffix:
Gender:
Credentials:LBS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S GODDARD BLVD APT 437
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2070
Mailing Address - Country:US
Mailing Address - Phone:267-226-7944
Mailing Address - Fax:
Practice Address - Street 1:600 REED RD STE 101
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3505
Practice Address - Country:US
Practice Address - Phone:484-326-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-25-79358103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst