Healthcare Provider Details

I. General information

NPI: 1326755539
Provider Name (Legal Business Name): ERICA ELENA WATSON DHSC, CNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LAKE ST
LEDYARD CT
06339-1628
US

IV. Provider business mailing address

25 LAKE ST
LEDYARD CT
06339-1628
US

V. Phone/Fax

Practice location:
  • Phone: 860-375-3477
  • Fax:
Mailing address:
  • Phone: 860-772-8734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1220895967
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number1251517965
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: