Provider Demographics
NPI:1104989540
Name:MINIOR, ERIN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:MINIOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-3321
Mailing Address - Country:US
Mailing Address - Phone:508-674-0982
Mailing Address - Fax:
Practice Address - Street 1:229 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5212
Practice Address - Country:US
Practice Address - Phone:401-331-1244
Practice Address - Fax:401-331-5772
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01122101YM0800X
MA1029405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1021500OtherBEACON HEALTHCARE
RI30222-7OtherBLUE CROSS
RI7743105OtherAETNA BEHAVIORAL HEALTH
RIEM24193Medicaid
RI409226OtherBLUE CHIP