MEDICARE: DR. ERICA LYNNE KING-TOLER PHD

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	103TC1900X	Counseling Psychologist	04656	MD
2	103TC1900X	Counseling Psychologist	017580	NY

General Provider Information

NPI Number	:	1588231153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA LYNNE KING-TOLER PHD

Provider Business Mailing Address
First Line	:	626 RIVERSIDE DR APT 15O
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-7222
Country	:	US
Telephone Number	:	917-796-3084
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 RIVERSIDE DR APT 15O
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-7222
Country	:	US
Telephone Number	:	917-796-3084
Fax Number	:

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

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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