Provider Demographics
NPI:1952883464
Name:MESOPOTANESE, ERICA KIM (PSYD, BCBA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:KIM
Last Name:MESOPOTANESE
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:KIM
Other - Last Name:MINDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, BCBA
Mailing Address - Street 1:51 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4146
Mailing Address - Country:US
Mailing Address - Phone:973-220-0075
Mailing Address - Fax:
Practice Address - Street 1:1115 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3641
Practice Address - Country:US
Practice Address - Phone:973-220-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-04-2022103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst