Provider Demographics
NPI:1497381784
Name:THORPE, EMMALYN
Entity Type:Individual
Prefix:
First Name:EMMALYN
Middle Name:
Last Name:THORPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1107
Mailing Address - Country:US
Mailing Address - Phone:508-344-3995
Mailing Address - Fax:
Practice Address - Street 1:12 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1107
Practice Address - Country:US
Practice Address - Phone:508-344-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst