Provider Demographics
NPI:1578849287
Name:FINE, EMILY BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:BETH
Last Name:FINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1273
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1273
Mailing Address - Country:US
Mailing Address - Phone:909-480-8235
Mailing Address - Fax:909-354-3363
Practice Address - Street 1:3281 E GUASTI RD STE 700
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7643
Practice Address - Country:US
Practice Address - Phone:909-480-8235
Practice Address - Fax:909-354-3363
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23742103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical