Provider Demographics
NPI:1891282794
Name:EDGINGTON, EMILY JEAN (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:EDGINGTON
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 BRADFORD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-2324
Mailing Address - Country:US
Mailing Address - Phone:904-872-4797
Mailing Address - Fax:
Practice Address - Street 1:235 GEORGIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4516
Practice Address - Country:US
Practice Address - Phone:904-872-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4169-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst