Provider Demographics
NPI:1124473582
Name:ERGIN, ESRA (MS ED)
Entity type:Individual
Prefix:
First Name:ESRA
Middle Name:
Last Name:ERGIN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 51ST AVE
Mailing Address - Street 2:APT.2D
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3919
Mailing Address - Country:US
Mailing Address - Phone:646-255-0495
Mailing Address - Fax:
Practice Address - Street 1:8830 51ST AVE
Practice Address - Street 2:APT.2D
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3919
Practice Address - Country:US
Practice Address - Phone:646-255-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1079967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst