Healthcare Provider Details

I. General information

NPI: 1962511691
Provider Name (Legal Business Name): ANTOINETTE L. ERICKSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: 'TONI' ERICKSON

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BROADWAY ST SUITE 205
BOULDER CO
80305-3343
US

IV. Provider business mailing address

193 N CEDAR BROOK RD
BOULDER CO
80304-0417
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-4234
  • Fax: 303-442-1630
Mailing address:
  • Phone: 303-440-4234
  • Fax: 440-442-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989635
License Number StateCO

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: