Provider Demographics
NPI:1104226745
Name:DELORME, EMMANUELLA
Entity type:Individual
Prefix:
First Name:EMMANUELLA
Middle Name:
Last Name:DELORME
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 1:5246 N ORANGE BLOSSOM TRL APT 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1043
Mailing Address - Country:US
Mailing Address - Phone:407-459-3395
Mailing Address - Fax:
Practice Address - Street 1:7225 WOODRIDGE PARK DR
Practice Address - Street 2:8102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818
Practice Address - Country:US
Practice Address - Phone:407-459-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician