Healthcare Provider Details

I. General information

NPI: 1982491155
Provider Name (Legal Business Name): ERICA TIFFANY PAGE MSW, PPSC-SSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 LAKE EARL DR
CRESCENT CITY CA
95531-7909
US

IV. Provider business mailing address

6900 LAKE EARL DR
CRESCENT CITY CA
95531-7909
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-0360
  • Fax:
Mailing address:
  • Phone: 707-464-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberASW137399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: