MEDICARE: ERICA ELIZABETH DILLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P81319	NY

General Provider Information

NPI Number	:	1104105063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA ELIZABETH DILLS

Provider Business Mailing Address
First Line	:	1669 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2009
Country	:	US
Telephone Number	:	718-467-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1669 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2009
Country	:	US
Telephone Number	:	718-467-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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