Healthcare Provider Details

I. General information

NPI: 1063905214
Provider Name (Legal Business Name): EMMIE ROSE HEBERT PHD, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WASHINGTON ST NE STE A1
ALBUQUERQUE NM
87113-1861
US

IV. Provider business mailing address

8500 WASHINGTON ST NE STE A1
ALBUQUERQUE NM
87113-1861
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-3837
  • Fax: 877-828-1550
Mailing address:
  • Phone: 505-828-3837
  • Fax: 877-828-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1670
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-38500
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0005389
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: