Healthcare Provider Details

I. General information

NPI: 1770855124
Provider Name (Legal Business Name): EMILY KATE RUBIO PHD, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 08/12/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 BRIARCLIFF RD NE
ATLANTA GA
30329-4010
US

IV. Provider business mailing address

1920 BRIARCLIFF RD NE
ATLANTA GA
30329-4010
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9400
  • Fax: 404-785-9068
Mailing address:
  • Phone: 404-785-9400
  • Fax: 404-785-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004622
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: