Provider Demographics
NPI:1376430116
Name:MARCIANO, AMY (PPS, LEP3788, BCBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:PPS, LEP3788, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30787 MAINMAST DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1935
Mailing Address - Country:US
Mailing Address - Phone:805-304-9580
Mailing Address - Fax:
Practice Address - Street 1:30787 MAINMAST DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1935
Practice Address - Country:US
Practice Address - Phone:805-304-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3788103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool