MEDICARE: MISS ERICA LAUREN JANSON PSYD

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	103TC0700X	Clinical Psychologist	003457	CT

General Provider Information

NPI Number	:	1972701522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERICA LAUREN JANSON PSYD

Provider Business Mailing Address
First Line	:	85 RIO DEL NORTE RD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32095-4862
Country	:	US
Telephone Number	:	860-539-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	6058 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2358
Country	:	US
Telephone Number	:	860-539-3651
Fax Number	:

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	01/31/2023

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