Provider Demographics
NPI:1528581758
Name:MALMGREN, EMMA L
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:L
Last Name:MALMGREN
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 1:11046 STUART MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1013
Mailing Address - Country:US
Mailing Address - Phone:540-680-8275
Mailing Address - Fax:703-620-0968
Practice Address - Street 1:11046 STUART MILL RD
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1013
Practice Address - Country:US
Practice Address - Phone:540-680-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11936236103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1-19-36236OtherBOARD CERTIFIED BEHAVIOR ANALYST
VA106S00000XOtherBEHAVIOR TECHNICIAN