MEDICARE: TERI ERCOLI

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1700010048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI ERCOLI

Provider Business Mailing Address
First Line	:	913 18TH ST APT 4
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-3251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11965 VENICE BLVD STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3954
Country	:	US
Telephone Number	:	310-266-8178
Fax Number	:

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

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	06/30/2024

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Directions to “ TERI ERCOLI ” Practice Location

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