=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245719616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIKA NICOLE MEAD CASAC-T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2018
-----------------------------------------------------
Last Update Date | 08/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 942 ROUTE 376
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-6483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-765-2366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 YEOMAN RD
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12550-2667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-245-8770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 34375
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------