MEDICARE: DR. KEITH ALLAN ERICKSON PH.D.

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	103TC0700X	Clinical Psychologist	PSY1879	DC

General Provider Information

NPI Number	:	1275628273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH ALLAN ERICKSON PH.D.

Provider Business Mailing Address
First Line	:	2000 P ST NW
Second Line	:	STE 610
City	:	WASHINGTON
State	:	DC
Zip	:	20036-6920
Country	:	US
Telephone Number	:	202-441-0689
Fax Number	:	202-521-9319

Provider Business Practice Location Address
First Line	:	2000 P ST NW
Second Line	:	STE 610
City	:	WASHINGTON
State	:	DC
Zip	:	20036-6920
Country	:	US
Telephone Number	:	202-441-0689
Fax Number	:	202-521-9319

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/06/2011

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