Provider Demographics
NPI:1639887789
Name:ALLEN, EMMA ALISE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ALISE
Last Name:ALLEN
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 1:67 S BROAD ST # 2
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2116
Mailing Address - Country:US
Mailing Address - Phone:570-269-2308
Mailing Address - Fax:
Practice Address - Street 1:1991 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3173
Practice Address - Country:US
Practice Address - Phone:570-931-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst