Provider Demographics
NPI:1033706973
Name:VANDERBURG, EMILY CHRISTINE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CHRISTINE
Last Name:VANDERBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 BARONESS WAY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7632
Mailing Address - Country:US
Mailing Address - Phone:407-757-7375
Mailing Address - Fax:
Practice Address - Street 1:247 W VOORHIS AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5432
Practice Address - Country:US
Practice Address - Phone:386-795-5695
Practice Address - Fax:386-777-3850
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-25-81588103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician