Provider Demographics
NPI:1699073353
Name:DUBUQUE, ERICK MARK (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:MARK
Last Name:DUBUQUE
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CORAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2017
Mailing Address - Country:US
Mailing Address - Phone:775-225-6980
Mailing Address - Fax:
Practice Address - Street 1:1405 E BURNETT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1577
Practice Address - Country:US
Practice Address - Phone:502-588-0724
Practice Address - Fax:502-588-0721
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA# 1-08-4322103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst