Healthcare Provider Details

I. General information

NPI: 1104989540
Provider Name (Legal Business Name): ERIN MINIOR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 WATERMAN ST
PROVIDENCE RI
02906-5212
US

IV. Provider business mailing address

618 WOOD ST
SOMERSET MA
02726-3321
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-1244
  • Fax: 401-331-5772
Mailing address:
  • Phone: 508-674-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW01122
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1029405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: