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General NPI Number Information
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NPI Number | 1427593706
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Entity Type | Individual
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Provider Name | ERICKA FORTSON LISW
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Gender | Female
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 3333 BURNET AVE # 3014
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-4788
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Fax | 513-636-2511
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Provider Business Mailing Address
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Address Line | 3333 BURNET AVE # 5021
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-5278
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Fax | 513-636-2511
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1600662
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License Number State | OH
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