Provider Demographics
NPI:1891282794
Name:EDGINGTON, EMILY JEAN (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:EDGINGTON
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ATWOOD SQ APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3115
Mailing Address - Country:US
Mailing Address - Phone:904-872-4797
Mailing Address - Fax:
Practice Address - Street 1:23 CROSBY DR STE 300
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1423
Practice Address - Country:US
Practice Address - Phone:781-832-3146
Practice Address - Fax:781-832-3146
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4169-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst