Provider Demographics
NPI:1578847497
Name:DORSI, ERICA M (BCBA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:M
Last Name:DORSI
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 1:300 CONSTITUTION AVE
Mailing Address - Street 2:362
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 CONSTITUTION AVE
Practice Address - Street 2:362
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5074
Practice Address - Country:US
Practice Address - Phone:201-704-5237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7024103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst