Provider Demographics
NPI:1265848451
Name:HALL, EZRA (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:EZRA
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-0442
Mailing Address - Country:US
Mailing Address - Phone:304-290-4262
Mailing Address - Fax:304-212-0627
Practice Address - Street 1:1010 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1683
Practice Address - Country:US
Practice Address - Phone:304-290-4262
Practice Address - Fax:304-212-0627
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst