Healthcare Provider Details

I. General information

NPI: 1306214382
Provider Name (Legal Business Name): ERICA VAZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 PLEASANT ST
LYNN MA
01901-1524
US

IV. Provider business mailing address

4 1ST ST APT 8004
SALEM MA
01970-7214
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-4400
  • Fax:
Mailing address:
  • Phone: 603-340-8569
  • 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: