Healthcare Provider Details

I. General information

NPI: 1265584239
Provider Name (Legal Business Name): ERICA L HERNANDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA L FREEMAN LCSW

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 E 13TH AVE STE 106
EUGENE OR
97401-4268
US

IV. Provider business mailing address

1400 HIGH ST STE C1
EUGENE OR
97401-4192
US

V. Phone/Fax

Practice location:
  • Phone: 541-543-8568
  • Fax:
Mailing address:
  • Phone: 541-345-7010
  • Fax: 541-343-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3688
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierL3688
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerLCSW SOCIAL WORK BOARD
# 2
Identifier50060860
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: