Provider Demographics
NPI:1740087147
Name:MORENO, ERICA (MED, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MED, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COTTAGE ST APT 204
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3351
Mailing Address - Country:US
Mailing Address - Phone:617-785-5768
Mailing Address - Fax:
Practice Address - Street 1:165 COTTAGE ST APT 204
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3351
Practice Address - Country:US
Practice Address - Phone:617-785-5768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-23-65290103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst