Provider Demographics
NPI:1316008501
Name:REDDY, ERIN (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
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 1:2222 MARTIN
Mailing Address - Street 2:SUITE 170
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1458
Mailing Address - Country:US
Mailing Address - Phone:949-474-5577
Mailing Address - Fax:949-474-5575
Practice Address - Street 1:2222 MARTIN
Practice Address - Street 2:SUITE 170
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1458
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:949-474-5575
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23760103TC0700X, 103TC2200X, 103TB0200X, 103TF0000X, 103TP2701X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities