Provider Demographics
NPI:1700187044
Name:ANDRESEN, ERICA MARIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:MARIE
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:KREUTZIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:47 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1419
Mailing Address - Country:US
Mailing Address - Phone:650-380-4260
Mailing Address - Fax:
Practice Address - Street 1:47 HIGH ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1419
Practice Address - Country:US
Practice Address - Phone:650-380-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-03-1061103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst