Provider Demographics
NPI:1487163986
Name:WALLER, EMILY (LMHC-LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:LMHC-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-2722
Mailing Address - Country:US
Mailing Address - Phone:914-361-5037
Mailing Address - Fax:
Practice Address - Street 1:101 GROVE ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1844
Practice Address - Country:US
Practice Address - Phone:917-880-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009516-1101YM0800X
CT004951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health