MEDICARE: ERICKA DEROSE

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	101YM0800X	Mental Health Counselor	18-P141040-01	NY

General Provider Information

NPI Number	:	1760336341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA DEROSE

Provider Business Mailing Address
First Line	:	317 WESTWOOD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5319
Country	:	US
Telephone Number	:	917-756-4549
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 NEW DORP LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3050
Country	:	US
Telephone Number	:	646-258-7970
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “ ERICKA DEROSE ” Practice Location

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