Healthcare Provider Details

I. General information

NPI: 1811278575
Provider Name (Legal Business Name): ERIKA UPDEGROVE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 COX RD
GLEN ALLEN VA
23060-6802
US

IV. Provider business mailing address

6 SOUTHSIDE RD
DANVERS MA
01923-1409
US

V. Phone/Fax

Practice location:
  • Phone: 860-788-6404
  • Fax: 860-829-0495
Mailing address:
  • Phone: 978-762-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number022916
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: