Healthcare Provider Details

I. General information

NPI: 1730510306
Provider Name (Legal Business Name): ERIN SOMERS MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 EDGEMAR AVENUE
PACIFICA CA
94044
US

IV. Provider business mailing address

435 EDGEMAR AVE
PACIFICA CA
94044-1961
US

V. Phone/Fax

Practice location:
  • Phone: 650-877-8642
  • Fax:
Mailing address:
  • Phone: 650-877-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: