Healthcare Provider Details

I. General information

NPI: 1245166073
Provider Name (Legal Business Name): MS. KAYLEY ERICSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 UNIVERSITY PLZ
HACKENSACK NJ
07601-6208
US

IV. Provider business mailing address

542 AMHERST ST STE B
NASHUA NH
03063-1016
US

V. Phone/Fax

Practice location:
  • Phone: 561-323-6593
  • Fax: 999-999-9999
Mailing address:
  • Phone: 561-323-6593
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90799
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: