Provider Demographics
NPI:1902520349
Name:REIS, ERICA LEE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEE
Last Name:REIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ARTHUR PAQUIN WAY
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2646
Mailing Address - Country:US
Mailing Address - Phone:508-232-5103
Mailing Address - Fax:
Practice Address - Street 1:639 GRANITE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5366
Practice Address - Country:US
Practice Address - Phone:844-902-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician