Healthcare Provider Details

I. General information

NPI: 1417723354
Provider Name (Legal Business Name): ERICCA KEITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HEWITT LN
SICKLERVILLE NJ
08081-2547
US

IV. Provider business mailing address

17 HEWITT LN
SICKLERVILLE NJ
08081-2547
US

V. Phone/Fax

Practice location:
  • Phone: 856-425-2383
  • Fax: 999-999-9999
Mailing address:
  • Phone: 856-425-2383
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06196900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: