Provider Demographics
NPI:1083986152
Name:TRUDEAU, EMILY BETH
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BETH
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:BETH
Other - Last Name:WALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LABA
Mailing Address - Street 1:11 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2013
Practice Address - Country:US
Practice Address - Phone:978-821-9810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA565103K00000X
1-15-19006103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst