Healthcare Provider Details

I. General information

NPI: 1477978260
Provider Name (Legal Business Name): PAMELA ERAZO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 09/03/2026
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PILLING STREET
BROOKLYN NY
11207
US

IV. Provider business mailing address

6324 84TH PL
MIDDLE VILLAGE NY
11379-1953
US

V. Phone/Fax

Practice location:
  • Phone: 718-908-8000
  • Fax:
Mailing address:
  • Phone: 718-264-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012891
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: