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NPI Code Detail

MEDICARE: ERICA MAZUR M.ED., BCBA

MEDICARE:   ERICA  MAZUR  M.ED., BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-19-34620NC

General Provider Information

NPI Number : 1932664018
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA MAZUR M.ED., BCBA
Provider Business Mailing Address
First Line : 3820 RANDOLPH HEIGHTS DR STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-7566
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3820 RANDOLPH HEIGHTS DR STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-7566
Country : US
Telephone Number : 980-819-0010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2019
Last Update Date : 08/03/2023

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