Provider Demographics
NPI:1124142252
Name:SALOMON, ERICA DAVIDA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DAVIDA
Last Name:SALOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 5TH AVE
Mailing Address - Street 2:#3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3005
Mailing Address - Country:US
Mailing Address - Phone:212-505-5736
Mailing Address - Fax:646-602-9369
Practice Address - Street 1:197 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5507
Practice Address - Country:US
Practice Address - Phone:212-505-5736
Practice Address - Fax:646-602-9369
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58341361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245221Medicaid