Healthcare Provider Details

I. General information

NPI: 1568719086
Provider Name (Legal Business Name): ERIN SHERIDAN LADC, LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN SHERIDAN LADC, LPC, LMHC

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 10/04/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST # 120
BRIMFIELD MA
01010-9800
US

IV. Provider business mailing address

1 MAIN ST # 120
BRIMFIELD MA
01010-9800
US

V. Phone/Fax

Practice location:
  • Phone: 860-362-0770
  • Fax: 860-362-0771
Mailing address:
  • Phone: 860-362-0770
  • Fax: 860-779-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001092
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003436
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12596MHCC
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: