Healthcare Provider Details

I. General information

NPI: 1225666480
Provider Name (Legal Business Name): ERIKA GONZALEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5945 161ST ST
FRESH MEADOWS NY
11365-1414
US

IV. Provider business mailing address

820 CATON AVE
BROOKLYN NY
11218-2604
US

V. Phone/Fax

Practice location:
  • Phone: 718-395-4522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12152964
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1873967
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: