Provider Demographics
NPI:1104200054
Name:EMILIANI, NICOLE (LBS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:EMILIANI
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1366
Mailing Address - Country:US
Mailing Address - Phone:570-499-3023
Mailing Address - Fax:
Practice Address - Street 1:1150 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1366
Practice Address - Country:US
Practice Address - Phone:570-499-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001637103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst