Healthcare Provider Details

I. General information

NPI: 1164909537
Provider Name (Legal Business Name): STEPHANIE MARIE ERICKSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S WHITE DR
CHANDLER AZ
85249-5900
US

IV. Provider business mailing address

4101 E BASELINE RD APT 1321
GILBERT AZ
85234-9118
US

V. Phone/Fax

Practice location:
  • Phone: 480-224-3806
  • Fax:
Mailing address:
  • Phone: 480-452-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW18886
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: