MEDICARE: SANDRA ERICKSON LCSW

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	1041C0700X	Clinical Social Worker	078222	NY

General Provider Information

NPI Number	:	1508912296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA ERICKSON LCSW

Provider Business Mailing Address
First Line	:	132 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8302
Country	:	US
Telephone Number	:	631-647-2530
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8302
Country	:	US
Telephone Number	:	516-697-2042
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	01/18/2024

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