Provider Demographics
NPI:1750899670
Name:DISPOTO, EMILY (MMFT, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DISPOTO
Suffix:
Gender:F
Credentials:MMFT, BCBA, LBA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MOORHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:142 KALOKO LN APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1597
Mailing Address - Country:US
Mailing Address - Phone:856-305-7910
Mailing Address - Fax:
Practice Address - Street 1:142 KALOKO LN APT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-1597
Practice Address - Country:US
Practice Address - Phone:856-305-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-16-23375106S00000X
HIBA-702103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBA-702OtherBEHAVIOR ANALYSIS