Basic Information
| Provider Information | |||||||||
| NPI: | 1548751993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUCHAINE | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | M.S. BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4705 CROSSWIND CT APT 10 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329048456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218060510 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 475 S JOHN RODES BLVD | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329041093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212411170 | ||||||||
| FaxNumber: | 3212411171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2018 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-18-62504 | FL | N | 103K00000X | BACB449375 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.