MEDICARE: MS. EMILY WAINWRIGHT BCBA, LBA

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	103K00000X	Behavior Analyst	LBA00196	RI

General Provider Information

NPI Number	:	1487297222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY WAINWRIGHT BCBA, LBA

Provider Business Mailing Address
First Line	:	154 BEAR HILL RD APT 605
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-6023
Country	:	US
Telephone Number	:	401-808-0342
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD STE B101
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4165
Country	:	US
Telephone Number	:	401-294-3990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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