Healthcare Provider Details

I. General information

NPI: 1235818626
Provider Name (Legal Business Name): ERIC PCHOLINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 WYOMING AVE APT 5
LOS ANGELES CA
90025-2441
US

IV. Provider business mailing address

11520 WYOMING AVE APT 5
LOS ANGELES CA
90025-2441
US

V. Phone/Fax

Practice location:
  • Phone: 860-510-2187
  • Fax:
Mailing address:
  • Phone: 860-510-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: