Healthcare Provider Details

I. General information

NPI: 1821771452
Provider Name (Legal Business Name): ERIN LEE MCVICAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 WELLINGTON RD
MILFORD CT
06461-1641
US

IV. Provider business mailing address

9 NISTA DR
HAMDEN CT
06518-2432
US

V. Phone/Fax

Practice location:
  • Phone: 203-307-3030
  • Fax:
Mailing address:
  • Phone: 304-820-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13249
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: