Provider Demographics
NPI:1891147948
Name:DELALLA, TAYLOR EMILY (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:EMILY
Last Name:DELALLA
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:MS
Other - First Name:TAYLOR
Other - Middle Name:EMILY
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:30 CATHEDRAL AVE APT 5D
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-2016
Mailing Address - Country:US
Mailing Address - Phone:516-428-4505
Mailing Address - Fax:
Practice Address - Street 1:30 CATHEDRAL AVE APT 5D
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-2016
Practice Address - Country:US
Practice Address - Phone:516-428-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001698103K00000X
103TB0200X
1-18-33967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral