Provider Demographics
NPI:1245723329
Name:ROBERTSON, ERICA (BCBA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ROBERTSON
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 1:1834 FIELDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3029
Mailing Address - Country:US
Mailing Address - Phone:317-527-5437
Mailing Address - Fax:317-318-1356
Practice Address - Street 1:2519 E 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-4464
Practice Address - Country:US
Practice Address - Phone:317-527-5437
Practice Address - Fax:317-318-1356
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-16-20934106S00000X
IN1-18-33461103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300027366Medicaid