Provider Demographics
NPI:1902142441
Name:ELFERS, ERIN (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:ELFERS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-3132
Mailing Address - Country:US
Mailing Address - Phone:513-319-9310
Mailing Address - Fax:
Practice Address - Street 1:250 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071-3132
Practice Address - Country:US
Practice Address - Phone:513-319-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4832103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst