Provider Demographics
NPI:1689172041
Name:ANDERSON MAKSYM, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ANDERSON MAKSYM
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 1:16000 PEARL RD STE 208
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6082
Mailing Address - Country:US
Mailing Address - Phone:440-253-9383
Mailing Address - Fax:
Practice Address - Street 1:16000 PEARL RD STE 208
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6082
Practice Address - Country:US
Practice Address - Phone:216-375-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-17-28325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst