=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386131514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN STEPHANIE WEIL BCBA, LBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2018
-----------------------------------------------------
Last Update Date | 04/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1217 ELMHURST DR
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-5713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-591-0732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3119 QUAIL ROOST DR
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-5238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-744-1167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-15-19263
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------