Provider Demographics
NPI:1578815817
Name:WALL, ERIN P
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:P
Last Name:WALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4157
Mailing Address - Country:US
Mailing Address - Phone:516-424-1757
Mailing Address - Fax:516-354-6135
Practice Address - Street 1:10 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BELLEROSE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11001-4157
Practice Address - Country:US
Practice Address - Phone:516-424-1757
Practice Address - Fax:516-354-6135
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst