Provider Demographics
NPI:1710357751
Name:SMYDRA, ERIN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SMYDRA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 KINGSCROSS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4433
Mailing Address - Country:US
Mailing Address - Phone:804-221-7176
Mailing Address - Fax:
Practice Address - Street 1:1213 KINGSCROSS RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4433
Practice Address - Country:US
Practice Address - Phone:804-221-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000526103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst