Healthcare Provider Details

I. General information

NPI: 1245719616
Provider Name (Legal Business Name): ERIKA NICOLE MEAD CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 ROUTE 376
WAPPINGERS FALLS NY
12590-6483
US

IV. Provider business mailing address

14 YEOMAN RD
NEWBURGH NY
12550-2667
US

V. Phone/Fax

Practice location:
  • Phone: 845-765-2366
  • Fax:
Mailing address:
  • Phone: 845-245-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number34375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: