Healthcare Provider Details

I. General information

NPI: 1467804393
Provider Name (Legal Business Name): EMMA COLE PHD, ABPP, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2016
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E FAIRMOUNT AVE
BALTIMORE MD
21231-1534
US

IV. Provider business mailing address

2801 EASTERN AVE
BALTIMORE MD
21224-3811
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-4564
  • Fax: 443-923-4525
Mailing address:
  • Phone: 301-520-7692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY60327555
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number494216E
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: