Healthcare Provider Details

I. General information

NPI: 1548751993
Provider Name (Legal Business Name): ERICA LEE DAVIS M.S. BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA LEE DUCHAINE MS BCBA

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W NASA BLVD UNIT C-1
MELBOURNE FL
32901-2614
US

IV. Provider business mailing address

928 OSPREY LN
ROCKLEDGE FL
32955-6401
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-6199
  • Fax: 321-821-1975
Mailing address:
  • Phone: 321-806-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-62504
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB449375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: