MEDICARE: ERICA LEE DAVIS M.S. BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-18-62504	FL
2	103K00000X	Behavior Analyst	BACB449375	FL

General Provider Information

NPI Number	:	1548751993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA LEE DAVIS M.S. BCBA

Provider Business Mailing Address
First Line	:	928 OSPREY LN
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-6401
Country	:	US
Telephone Number	:	321-806-0510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 W NASA BLVD UNIT C-1
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2614
Country	:	US
Telephone Number	:	321-235-6199
Fax Number	:	321-821-1975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	02/18/2025

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