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NPI Code Detail

MEDICARE: EMILY JO BAKER BCABA

MEDICARE: EMILY JO BAKER BCABA
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
1106E00000XAssistant Behavior Analyst0134000343VA
2103K00000XBehavior Analyst0133003228VA

General Provider Information

NPI Number : 1114529310
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY JO BAKER BCABA
Provider Business Mailing Address
First Line : 1249 HAMILTON AVE SW
Second Line :
City : ROANOKE
State : VA
Zip : 24015-1738
Country : US
Telephone Number : 540-520-1939
Fax Number :
Provider Business Practice Location Address
First Line : 8000 TOWERS CRESCENT DR FL 13
Second Line :
City : VIENNA
State : VA
Zip : 22182-6211
Country : US
Telephone Number : 833-599-2560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2020
Last Update Date : 12/08/2023

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