Provider Demographics
NPI:1255627782
Name:FORMOSO, EMILIA IRENE (BCBA)
Entity type:Individual
Prefix:MISS
First Name:EMILIA
Middle Name:IRENE
Last Name:FORMOSO
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 1:829 QUINCY ST NW
Mailing Address - Street 2:#114
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5845
Mailing Address - Country:US
Mailing Address - Phone:703-929-8576
Mailing Address - Fax:
Practice Address - Street 1:829 QUINCY ST NW
Practice Address - Street 2:#114
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5845
Practice Address - Country:US
Practice Address - Phone:703-929-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-10-7780103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst