Healthcare Provider Details

I. General information

NPI: 1184697138
Provider Name (Legal Business Name): ERICA CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 ROUTE 202
SOMERS NY
10589-3222
US

IV. Provider business mailing address

380 ROUTE 202
SOMERS NY
10589-3222
US

V. Phone/Fax

Practice location:
  • Phone: 914-617-9068
  • Fax: 914-617-9068
Mailing address:
  • Phone: 914-617-9068
  • Fax: 914-669-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberRO44237 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: