Provider Demographics
NPI:1710540844
Name:BALLARD, ERICA (BCBA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BALLARD
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 1:67 SWEETFERN CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3739
Mailing Address - Country:US
Mailing Address - Phone:856-649-8628
Mailing Address - Fax:
Practice Address - Street 1:1880 GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-8721
Practice Address - Country:US
Practice Address - Phone:856-881-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-27741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-27741OtherBEHAVIOR ANALYST CERTIFICATION BOARD