Provider Demographics
NPI:1063066611
Name:TORRES, EMELY A (MASTERS BCBA)
Entity type:Individual
Prefix:MRS
First Name:EMELY
Middle Name:A
Last Name:TORRES
Suffix:
Gender:F
Credentials:MASTERS BCBA
Other - Prefix:
Other - First Name:EMELY
Other - Middle Name:A
Other - Last Name:LANTIGUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2056 CADES COVE WAY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3381
Mailing Address - Country:US
Mailing Address - Phone:908-220-6279
Mailing Address - Fax:
Practice Address - Street 1:12724 GRAN BAY PKWY W STE 410
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-9486
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-51033103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst