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General NPI Number Information
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NPI Number | 1184013146
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Entity Type | Individual
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Provider Name | ERICA LEE GEISEL BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 3440 US HIGHWAY 1 S STE 201
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6363
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Country | US
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Telephone | 877-823-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 399 W NEW ENGLAND DR
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City | ELKTON
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State | FL
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Zip | 32033-2068
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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