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General NPI Number Information
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NPI Number | 1205213683
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Entity Type | Individual
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Provider Name | ERICA ZELLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 267 E MAIN ST SUITE 22B
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City | SMITHTOWN
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State | NY
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Zip | 11787-2874
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Country | US
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Telephone | 631-320-1721
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Fax |
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Provider Business Mailing Address
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Address Line | 25 ROUTE 111 #1210
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City | SMITHTOWN
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State | NY
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Zip | 11787-7072
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Country | US
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Telephone | 631-863-9223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 090491
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License Number State | NY
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