Provider Demographics
NPI:1225491491
Name:WEBER, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7025 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8657
Mailing Address - Country:US
Mailing Address - Phone:208-947-0863
Mailing Address - Fax:
Practice Address - Street 1:7025 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8657
Practice Address - Country:US
Practice Address - Phone:208-947-0863
Practice Address - Fax:208-672-0324
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA109694106H00000X
ID10463106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist