Provider Demographics
NPI:1609136332
Name:PUSKAR, EMILY R (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:PUSKAR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2283 YEAGER DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-7747
Mailing Address - Country:US
Mailing Address - Phone:330-766-9267
Mailing Address - Fax:
Practice Address - Street 1:2283 YEAGER DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-7747
Practice Address - Country:US
Practice Address - Phone:330-766-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-14-10248103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst