Provider Demographics
NPI:1649842238
Name:WORDEN, EMILIE KATE
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:KATE
Last Name:WORDEN
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 1:2780 ANN ROU RD UNIT 2810
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5342
Mailing Address - Country:US
Mailing Address - Phone:407-627-5492
Mailing Address - Fax:
Practice Address - Street 1:2780 ANN ROU RD UNIT 2810
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5342
Practice Address - Country:US
Practice Address - Phone:407-627-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician