Provider Demographics
NPI:1316483936
Name:SAMPSON, EMILY (BCBA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BARNARD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-6501
Mailing Address - Country:US
Mailing Address - Phone:603-387-9615
Mailing Address - Fax:
Practice Address - Street 1:23 WEST ST
Practice Address - Street 2:UNIT #3
Practice Address - City:ASHLAND
Practice Address - State:NH
Practice Address - Zip Code:03217-4219
Practice Address - Country:US
Practice Address - Phone:603-387-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-16-24468103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst