MEDICARE: ERICA CERDA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	304861	MN
2	104100000X	Social Worker	5152	ND
3	1041C0700X	Clinical Social Worker	26096	MN

General Provider Information

NPI Number	:	1801333125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA CERDA

Provider Business Mailing Address
First Line	:	1913 S WASHINGTON ST STE C
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6339
Country	:	US
Telephone Number	:	701-317-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 S WASHINGTON ST STE C
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6339
Country	:	US
Telephone Number	:	701-317-6590
Fax Number	:

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

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	11/10/2021

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Directions to “ ERICA CERDA ” Practice Location

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