Provider Demographics
NPI:1710377593
Name:BARE, EMILY (BCBA, MA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BARE
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 OLMSTEAD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-1820
Mailing Address - Country:US
Mailing Address - Phone:203-247-4242
Mailing Address - Fax:
Practice Address - Street 1:254 OLMSTEAD HILL RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-1820
Practice Address - Country:US
Practice Address - Phone:203-247-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-10187103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst