Provider Demographics
NPI:1003507070
Name:BAMBERGER, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BAMBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BLONDELL CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2004
Mailing Address - Country:US
Mailing Address - Phone:443-610-1059
Mailing Address - Fax:
Practice Address - Street 1:2501 SMITH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2505
Practice Address - Country:US
Practice Address - Phone:347-255-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician