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General NPI Number Information
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NPI Number | 1255483004
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Entity Type | Individual
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Provider Name | ERICA BACKMANN M.A.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 1066 STORRS RD STE E
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City | STORRS
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State | CT
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Zip | 06268-2648
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Country | US
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Telephone | 860-933-0483
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Fax |
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Provider Business Mailing Address
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Address Line | 17 LAKESIDE DR
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City | ASHFORD
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State | CT
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Zip | 06278-1228
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Country | US
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Telephone | 860-933-0483
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001189
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License Number State | CT
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