Provider Demographics
NPI:1376893586
Name:YAMAGISHI, ERIKO (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ERIKO
Middle Name:
Last Name:YAMAGISHI
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 PITTSBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6008
Mailing Address - Country:US
Mailing Address - Phone:909-484-2848
Mailing Address - Fax:909-484-3504
Practice Address - Street 1:9531 PITTSBURGH AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6008
Practice Address - Country:US
Practice Address - Phone:909-484-2848
Practice Address - Fax:909-484-3504
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10024103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst