Provider Demographics
NPI:1477887099
Name:LERDAL, ERIK DUANE (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:DUANE
Last Name:LERDAL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1420
Mailing Address - Country:US
Mailing Address - Phone:401-217-9817
Mailing Address - Fax:508-363-1213
Practice Address - Street 1:200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1420
Practice Address - Country:US
Practice Address - Phone:401-217-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1095091103K00000X
1095091103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA133648OtherCOMMONWEALTH OF MASSACHUSETTS STATE LICENSING BOARD
1095091OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD