Provider Demographics
NPI:1275139214
Name:TERATSUYAN, EMILY (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TERATSUYAN
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 1:1135 E MAPLE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4419
Mailing Address - Country:US
Mailing Address - Phone:818-987-9005
Mailing Address - Fax:
Practice Address - Street 1:1135 E MAPLE ST APT 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4419
Practice Address - Country:US
Practice Address - Phone:818-987-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-46362103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst