MEDICARE: EMILY DAY PSYCHOTHERAPY

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
1	251S00000X	Community/Behavioral Health Agency	A11046	NC

General Provider Information

NPI Number	:	1265813679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY DAY PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	104 HANNA ST
Second Line	:
City	:	CARRBORO
State	:	NC
Zip	:	27510-1316
Country	:	US
Telephone Number	:	410-353-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 N COLUMBIA ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-2119
Country	:	US
Telephone Number	:	410-353-5270
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY V DAY
Credential	:	LCPA
Telephone Number	:	410-353-5270

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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