Provider Demographics
NPI:1134738370
Name:COMP, EMMA DIANE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:DIANE
Last Name:COMP
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD TWP
Mailing Address - State:ME
Mailing Address - Zip Code:04406-4013
Mailing Address - Country:US
Mailing Address - Phone:774-644-0581
Mailing Address - Fax:
Practice Address - Street 1:1093 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-3717
Practice Address - Country:US
Practice Address - Phone:207-564-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2025-03-31
Deactivation Date:2025-02-28
Deactivation Code:
Reactivation Date:2025-03-31
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
MEXL7982101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician