MEDICARE: MS. EMILY R COGDELL HSP-PA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3368	NC
2	103TB0200X	Cognitive & Behavioral Psychologist	3368	NC
3	103TC0700X	Clinical Psychologist	3368	NC
4	171000000X	Military Health Care Provider	1-07-3251
5	103K00000X	Behavior Analyst	1-07-3251	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275707523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY R COGDELL HSP-PA, BCBA

Provider Business Mailing Address
First Line	:	308 GREENVILLE BLVD SE
Second Line	:	SUITE B-1
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5758
Country	:	US
Telephone Number	:	252-341-4192
Fax Number	:	866-309-9297

Provider Business Practice Location Address
First Line	:	308 GREENVILLE BLVD SE
Second Line	:	SUITE B1
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5758
Country	:	US
Telephone Number	:	252-341-4192
Fax Number	:	866-309-9297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	03/22/2023

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