Provider Demographics
NPI:1518710318
Name:GIBBONS, ERIN LAURA (BCBA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LAURA
Last Name:GIBBONS
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 1:158 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832
Mailing Address - Country:US
Mailing Address - Phone:978-270-7996
Mailing Address - Fax:
Practice Address - Street 1:39 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1428
Practice Address - Country:US
Practice Address - Phone:978-956-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst