Provider Demographics
NPI:1922884253
Name:JUBERG, EMELIE
Entity Type:Individual
Prefix:
First Name:EMELIE
Middle Name:
Last Name:JUBERG
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 1:401 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4215
Mailing Address - Country:US
Mailing Address - Phone:786-579-0229
Mailing Address - Fax:
Practice Address - Street 1:401 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4215
Practice Address - Country:US
Practice Address - Phone:786-579-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician