Provider Demographics
NPI:1508110149
Name:BARON, EMMA ROSE
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:ROSE
Last Name:BARON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:CELINA
Other - Last Name:DUARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36422 PAR LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8034
Mailing Address - Country:US
Mailing Address - Phone:909-263-0755
Mailing Address - Fax:
Practice Address - Street 1:330 6TH ST STE 110
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3312
Practice Address - Country:US
Practice Address - Phone:909-307-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW830591041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program