Provider Demographics
NPI:1225876642
Name:NICKERSON, ERIN LEE (BCBA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CORBIN DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4488
Mailing Address - Country:US
Mailing Address - Phone:603-556-1311
Mailing Address - Fax:
Practice Address - Street 1:5 STRATFORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4213
Practice Address - Country:US
Practice Address - Phone:781-366-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-21-47662103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst