Provider Demographics
NPI:1164751970
Name:SULLIVAN, ERIN MARY (BCBA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARY
Last Name:SULLIVAN
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 1:93 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1811
Mailing Address - Country:US
Mailing Address - Phone:207-650-8041
Mailing Address - Fax:
Practice Address - Street 1:93 LEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1811
Practice Address - Country:US
Practice Address - Phone:207-650-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0-07-2354103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst