Provider Demographics
NPI:1083328066
Name:DEFILIPPO, ERICA (BCBA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DEFILIPPO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-4417
Mailing Address - Country:US
Mailing Address - Phone:603-660-2297
Mailing Address - Fax:
Practice Address - Street 1:99 E SHORE DR
Practice Address - Street 2:
Practice Address - City:WEARE
Practice Address - State:NH
Practice Address - Zip Code:03281-4417
Practice Address - Country:US
Practice Address - Phone:603-660-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-20-45410103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1-20-45410Medicaid