Healthcare Provider Details

I. General information

NPI: 1932651098
Provider Name (Legal Business Name): ERICA OPPENHEIMER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 FORT WADE RD STE 100
PONTE VEDRA BEACH FL
32081-5114
US

IV. Provider business mailing address

90 FORT WADE RD STE 100
PONTE VEDRA BEACH FL
32081-5114
US

V. Phone/Fax

Practice location:
  • Phone: 347-377-0973
  • Fax:
Mailing address:
  • Phone: 347-377-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113436
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098213
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: