Provider Demographics
NPI:1942672829
Name:WALSH, EMILY (BCBA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1214
Mailing Address - Country:US
Mailing Address - Phone:347-886-0070
Mailing Address - Fax:
Practice Address - Street 1:183 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1214
Practice Address - Country:US
Practice Address - Phone:347-886-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst