Healthcare Provider Details

I. General information

NPI: 1932613064
Provider Name (Legal Business Name): JOSE LUIS ERICE LAFONT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 09/29/2026
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 18TH ST NE APT L3
WASHINGTON DC
20002-4668
US

IV. Provider business mailing address

417 18TH ST NE APT L3
WASHINGTON DC
20002-4668
US

V. Phone/Fax

Practice location:
  • Phone: 305-764-1673
  • Fax:
Mailing address:
  • Phone: 305-764-1673
  • Fax: 305-786-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: