Provider Demographics
NPI:1124745047
Name:ZERVANOS, ERICA (MA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ZERVANOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S BAMBREY ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1020
Mailing Address - Country:US
Mailing Address - Phone:610-883-6129
Mailing Address - Fax:
Practice Address - Street 1:6703 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2109
Practice Address - Country:US
Practice Address - Phone:571-210-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional