Healthcare Provider Details

I. General information

NPI: 1629109160
Provider Name (Legal Business Name): ROSEMARY J ERICKSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 UNION PLACE
SUMMIT NJ
07901
US

IV. Provider business mailing address

22 LAKEVIEW TERRACE
WATCHUNG NJ
07069
US

V. Phone/Fax

Practice location:
  • Phone: 973-218-1776
  • Fax: 908-522-1995
Mailing address:
  • Phone: 908-222-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC00098500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: