Provider Demographics
NPI:1710644711
Name:YERGIN, EMMA ROSE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:YERGIN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31190 PORTSIDE DR APT 4303
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4307
Mailing Address - Country:US
Mailing Address - Phone:248-756-3375
Mailing Address - Fax:
Practice Address - Street 1:23800 W 10 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3199
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:718-865-5165
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst