Provider Demographics
NPI:1366741027
Name:WADE, EMILY G (BCBA)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:G
Last Name:WADE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:BRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:407-915-7729
Mailing Address - Fax:
Practice Address - Street 1:1140 KYLE WOOD LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4850
Practice Address - Country:US
Practice Address - Phone:813-548-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-14443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst