Provider Demographics
NPI:1275874703
Name:SUAZO, EMELY LETICIA (BCBA)
Entity Type:Individual
Prefix:
First Name:EMELY
Middle Name:LETICIA
Last Name:SUAZO
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 1:515 ULUMAWAO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4333
Mailing Address - Country:US
Mailing Address - Phone:808-782-6503
Mailing Address - Fax:
Practice Address - Street 1:515 ULUMAWAO ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4333
Practice Address - Country:US
Practice Address - Phone:808-782-6503
Practice Address - Fax:808-782-6503
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst