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NPI Code Detail

MEDICARE: MR. ERIC ROBERT ANDERSON LMSW

MEDICARE: MR. ERIC ROBERT ANDERSON LMSW
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
11041C0700XClinical Social Worker067747NY

General Provider Information

NPI Number : 1740367465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC ROBERT ANDERSON LMSW
Provider Business Mailing Address
First Line : 204 ONTARIO ST
Second Line :
City : LOCKPORT
State : NY
Zip : 14094-2736
Country : US
Telephone Number : 716-439-0494
Fax Number :
Provider Business Practice Location Address
First Line : 89 RIVER RD # B
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-5713
Country : US
Telephone Number : 716-693-9961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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