Provider Demographics
NPI:1306352299
Name:ROSE, ERIN (MS BCBA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 GRAND REGENCY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-3935
Mailing Address - Country:US
Mailing Address - Phone:913-709-7989
Mailing Address - Fax:
Practice Address - Street 1:11910 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5601
Practice Address - Country:US
Practice Address - Phone:877-350-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst