Provider Demographics
NPI:1467804393
Name:COLE, EMMA (PHD, ABPP, NCSP)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD, ABPP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3811
Mailing Address - Country:US
Mailing Address - Phone:301-520-7692
Mailing Address - Fax:
Practice Address - Street 1:1750 E FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1534
Practice Address - Country:US
Practice Address - Phone:443-923-4564
Practice Address - Fax:443-923-4525
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA494216E103TS0200X
WAPY60327555103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
42794OtherNATIONALLY CERTIFIED SCHOOL PSYCHOLOGIST
WA494216EOtherRESIDENCY PSYCHOLOGIST EDUCATIONAL STAFF ASSOCIATE
WAPY60327555OtherPSYCHOLOGIST LICENSE
8972OtherAMERICAN BOARD OF PROFESSIONAL PSYCHOLOFY