Healthcare Provider Details

I. General information

NPI: 1902410319
Provider Name (Legal Business Name): EMMA SWANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WHITING ST
NEW BRITAIN CT
06051-3184
US

IV. Provider business mailing address

11 ABBEY LN
SHELTON CT
06484-5101
US

V. Phone/Fax

Practice location:
  • Phone: 203-993-4484
  • Fax:
Mailing address:
  • Phone: 203-993-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1890
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: