Provider Demographics
NPI:1780939330
Name:BRAIN, EMILY JULIA (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:JULIA
Last Name:BRAIN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:JULIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:4020 NE 113TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5813
Mailing Address - Country:US
Mailing Address - Phone:206-234-8773
Mailing Address - Fax:
Practice Address - Street 1:4020 NE 113TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5813
Practice Address - Country:US
Practice Address - Phone:206-234-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-09-6379103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst