Healthcare Provider Details

I. General information

NPI: 1932553070
Provider Name (Legal Business Name): ERICA J. PATFIELD LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 MENTOR AVENUE BEACON HEALTH
MENTOR OH
44060-6412
US

IV. Provider business mailing address

9220 MENTOR AVENUE
MENTOR OH
44060-6412
US

V. Phone/Fax

Practice location:
  • Phone: 440-639-3509
  • Fax: 440-205-1009
Mailing address:
  • Phone: 440-354-9924
  • Fax: 877-242-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0034051
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1600164
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: