MEDICARE: ERICA LEA BARRETT MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	MH22798	FL

General Provider Information

NPI Number	:	1013478627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA LEA BARRETT MA

Provider Business Mailing Address
First Line	:	13504 CITICARDS WAY UNIT 2325
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-6529
Country	:	US
Telephone Number	:	814-969-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	13504 CITICARDS WAY UNIT 2325
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-6529
Country	:	US
Telephone Number	:	814-969-8228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	10/04/2024

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