Provider Demographics
NPI:1386131514
Name:WEIL, ERIN STEPHANIE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:STEPHANIE
Last Name:WEIL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5238
Mailing Address - Country:US
Mailing Address - Phone:334-744-1167
Mailing Address - Fax:
Practice Address - Street 1:1217 ELMHURST DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-5713
Practice Address - Country:US
Practice Address - Phone:804-591-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-15-19263103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst