Provider Demographics
NPI:1114481587
Name:BERMUDEZ, ERICKA (BCABA)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 MCGUIRE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5251
Mailing Address - Country:US
Mailing Address - Phone:678-622-6905
Mailing Address - Fax:
Practice Address - Street 1:2642 MCGUIRE DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5251
Practice Address - Country:US
Practice Address - Phone:678-622-6905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106E00000X
GA0-18-9385106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst