MEDICARE: ERICA KRIST MSW, LICSW

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	104100000X	Social Worker	228330	MA
2	1041C0700X	Clinical Social Worker	LICSW1121537	MA

General Provider Information

NPI Number	:	1962123273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA KRIST MSW, LICSW

Provider Business Mailing Address
First Line	:	1342 BELMONT ST STE 103
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-4437
Country	:	US
Telephone Number	:	508-960-1263
Fax Number	:	339-364-2600

Provider Business Practice Location Address
First Line	:	1 WASHINGTON ST
Second Line	:
City	:	TAUNTON
State	:	MA
Zip	:	02780-3960
Country	:	US
Telephone Number	:	508-828-9116
Fax Number	:

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

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	05/19/2026

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