Provider Demographics
NPI:1124308044
Name:FOSTER, EMMA Y (PHD)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:Y
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N BERGIN LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413-6729
Mailing Address - Country:US
Mailing Address - Phone:505-632-4389
Mailing Address - Fax:505-632-4371
Practice Address - Street 1:325 N BERGIN LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-6729
Practice Address - Country:US
Practice Address - Phone:505-632-4389
Practice Address - Fax:505-632-4371
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64434826Medicaid
NM23189738Medicaid