Healthcare Provider Details

I. General information

NPI: 1578374591
Provider Name (Legal Business Name): ERIKA ROQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 UNION ST
LAWRENCE MA
01840-1866
US

IV. Provider business mailing address

74 SULLIVAN AVE
LAWRENCE MA
01843-1012
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-7289
  • Fax:
Mailing address:
  • Phone: 978-943-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: