Healthcare Provider Details

I. General information

NPI: 1851450381
Provider Name (Legal Business Name): ANNIE ERICKSON LCSW, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5664 SW 60TH AVE
OCALA FL
34474-5677
US

IV. Provider business mailing address

5664 SW 60TH AVE
OCALA FL
34474-5677
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-5555
  • Fax: 352-291-9536
Mailing address:
  • Phone: 352-291-5555
  • Fax: 352-291-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1147
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3531
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: