Provider Demographics
NPI:1093250276
Name:BERGERON, EMILY GILCREASE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GILCREASE
Last Name:BERGERON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 DUNN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6467
Mailing Address - Country:US
Mailing Address - Phone:985-746-5008
Mailing Address - Fax:
Practice Address - Street 1:917 DUNN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6467
Practice Address - Country:US
Practice Address - Phone:985-746-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-16-24448103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst