Provider Demographics
NPI:1003556044
Name:TAYLOR, EMILY J (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 E HIGHLAND AVE UNIT 815
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-4428
Mailing Address - Country:US
Mailing Address - Phone:909-648-7643
Mailing Address - Fax:
Practice Address - Street 1:1255 E HIGHLAND AVE STE 107
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4652
Practice Address - Country:US
Practice Address - Phone:909-648-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical