Provider Demographics
NPI:1134438369
Name:GAGNON, ERICA LEE (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LEE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LEE
Other - Last Name:DEMARTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 AMESBURY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NH
Mailing Address - Zip Code:03858-3203
Mailing Address - Country:US
Mailing Address - Phone:603-560-2723
Mailing Address - Fax:
Practice Address - Street 1:39 AMESBURY RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NH
Practice Address - Zip Code:03858-3203
Practice Address - Country:US
Practice Address - Phone:603-560-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst