Provider Demographics
NPI:1275185951
Name:LIBBY, EMILY FAITH (MED, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:FAITH
Last Name:LIBBY
Suffix:
Gender:
Credentials:MED, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N STATE ROAD 7 STE 300
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5867
Mailing Address - Country:US
Mailing Address - Phone:561-323-6593
Mailing Address - Fax:877-754-5246
Practice Address - Street 1:254 N BROADWAY # 112
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2132
Practice Address - Country:US
Practice Address - Phone:561-903-1995
Practice Address - Fax:561-997-1246
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NH1-23-66650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician