Healthcare Provider Details

I. General information

NPI: 1851772982
Provider Name (Legal Business Name): ERICA DELLA JACONO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 PEACHTREE ST NE STE 1400
ATLANTA GA
30303-1749
US

IV. Provider business mailing address

191 PEACHTREE ST NE STE 1400
ATLANTA GA
30303-1749
US

V. Phone/Fax

Practice location:
  • Phone: 866-968-6342
  • Fax:
Mailing address:
  • Phone: 866-968-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008986
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: