Healthcare Provider Details

I. General information

NPI: 1295253474
Provider Name (Legal Business Name): ERICA BAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 N MAIN STREET EXT STE 101A
WALLINGFORD CT
06492-2449
US

IV. Provider business mailing address

350 STATE ST
NORTH HAVEN CT
06473-3108
US

V. Phone/Fax

Practice location:
  • Phone: 516-459-8909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: