Provider Demographics
NPI:1447490479
Name:WYNER, ERICA J (MA BCBA)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:J
Last Name:WYNER
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 1:7 MAXWELLS GRN APT 211
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 MAXWELLS GRN APT 211
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2691
Practice Address - Country:US
Practice Address - Phone:646-998-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2024-08-13
Deactivation Date:2010-10-04
Deactivation Code:
Reactivation Date:2012-07-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist