Provider Demographics
NPI:1720702111
Name:ERWIN, EDWINA A (RBT)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:A
Last Name:ERWIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 W AVENUE L14 APT 6
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3690
Mailing Address - Country:US
Mailing Address - Phone:323-365-4613
Mailing Address - Fax:
Practice Address - Street 1:17702 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-1635
Practice Address - Country:US
Practice Address - Phone:888-770-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician