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General NPI Number Information
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NPI Number | 1750509287
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Entity Type | Organization
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Legal Business Name | GAIL P ERICSON, LCSW
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 11022 S 51ST ST SUITE 100
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City | PHOENIX
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State | AZ
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Zip | 85044-4308
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Country | US
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Telephone | 480-753-1211
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Fax | 480-753-0060
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Provider Business Mailing Address
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Address Line | 4119 E CATHEDRAL ROCK DR
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City | PHOENIX
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State | AZ
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Zip | 85044-3707
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Country | US
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Telephone | 480-518-5550
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GAIL PAULA ERICSON
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Credential | LCSW
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Telephone | 480-753-1211
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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 | LCSW-2009
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License Number State | AZ
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