Healthcare Provider Details

I. General information

NPI: 1932593407
Provider Name (Legal Business Name): ERICA RAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WALKER AVE STE 120
PIKESVILLE MD
21208-4019
US

IV. Provider business mailing address

18007 SILVER LEAF DR
GAITHERSBURG MD
20877-3764
US

V. Phone/Fax

Practice location:
  • Phone: 410-205-2315
  • Fax:
Mailing address:
  • Phone: 910-779-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA400
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: