Provider Demographics
NPI:1992178339
Name:GRZYWACZ, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GRZYWACZ
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 1:51 WATER STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 WATER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4611
Practice Address - Country:US
Practice Address - Phone:617-923-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst