Provider Demographics
NPI:1194884213
Name:SMITH, ERICA (ND)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GEORGIAN CT
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-4035
Mailing Address - Country:US
Mailing Address - Phone:203-609-1167
Mailing Address - Fax:
Practice Address - Street 1:41 GEORGIAN CT
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-4035
Practice Address - Country:US
Practice Address - Phone:203-609-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016031-1235Z00000X
CT000715175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist