Provider Demographics
NPI:1740830629
Name:WEISMAN, ERICA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 72ND ST APT 21E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4544
Mailing Address - Country:US
Mailing Address - Phone:215-806-5307
Mailing Address - Fax:
Practice Address - Street 1:200 E 72ND ST APT 21E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4544
Practice Address - Country:US
Practice Address - Phone:215-806-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-19-36511103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst