Provider Demographics
NPI:1568787984
Name:DONNELLY, ERIN N (MED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:N
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 BRADWATER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3704
Mailing Address - Country:US
Mailing Address - Phone:703-635-9075
Mailing Address - Fax:
Practice Address - Street 1:3938 BRADWATER ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3704
Practice Address - Country:US
Practice Address - Phone:703-635-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5540103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst