Provider Demographics
NPI:1831995869
Name:CHAMPEAU, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CHAMPEAU
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 1:310 W 99TH ST APT 701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5422
Mailing Address - Country:US
Mailing Address - Phone:973-747-4798
Mailing Address - Fax:
Practice Address - Street 1:330 W 38TH ST RM 705
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-2515
Practice Address - Country:US
Practice Address - Phone:631-464-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126451101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor