Provider Demographics
NPI:1144876699
Name:FADGEN, EMILY BERMUDEZ (ATR-BC, LCPAT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:BERMUDEZ
Last Name:FADGEN
Suffix:
Gender:F
Credentials:ATR-BC, LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 BACK POINTE CT UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2574
Mailing Address - Country:US
Mailing Address - Phone:443-470-5084
Mailing Address - Fax:
Practice Address - Street 1:3508 BACK POINTE CT UNIT 1B
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2574
Practice Address - Country:US
Practice Address - Phone:215-906-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional