Provider Demographics
NPI:1578942090
Name:ENDEAN, EMILIA CLANCY
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:CLANCY
Last Name:ENDEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILIA
Other - Middle Name:
Other - Last Name:CLANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:581 ROCKAWAY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9169
Mailing Address - Country:US
Mailing Address - Phone:774-279-0982
Mailing Address - Fax:
Practice Address - Street 1:581 ROCKAWAY VALLEY RD
Practice Address - Street 2:
Practice Address - City:BOONTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07005-9169
Practice Address - Country:US
Practice Address - Phone:774-279-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst