Provider Demographics
NPI:1992410260
Name:PHILIPPE, EMMERSON
Entity type:Individual
Prefix:
First Name:EMMERSON
Middle Name:
Last Name:PHILIPPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EMMERSON
Other - Middle Name:
Other - Last Name:JEAN-PHILIPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, TEACHER
Mailing Address - Street 1:542 AMHERST ST STE B
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1016
Mailing Address - Country:US
Mailing Address - Phone:786-308-6657
Mailing Address - Fax:
Practice Address - Street 1:542 AMHERST ST STE B
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1016
Practice Address - Country:US
Practice Address - Phone:786-308-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-74743103K00000X
FLRBT-23-252193106S00000X
GA1-24-74743103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician