Provider Demographics
NPI:1386031003
Name:EMMERSON, NATASHA (PHD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:EMMERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7817
Mailing Address - Country:US
Mailing Address - Phone:949-200-6097
Mailing Address - Fax:
Practice Address - Street 1:366 SAN MIGUEL DR
Practice Address - Street 2:SUITE 209
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7817
Practice Address - Country:US
Practice Address - Phone:949-200-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26992103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist