Provider Demographics
NPI:1093175291
Name:MOON, EMMA ISABEL (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ISABEL
Last Name:MOON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8032 E BYNUM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3231
Mailing Address - Country:US
Mailing Address - Phone:720-670-8357
Mailing Address - Fax:
Practice Address - Street 1:8032 E BYNUM ST APT 303
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3231
Practice Address - Country:US
Practice Address - Phone:720-670-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 106S00000X
CA1-21-51967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician