Provider Demographics
NPI:1285862219
Name:ALBERT, ERICA (LICSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ALBERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:GEBHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:100 LAFAYETTE ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6008
Mailing Address - Country:US
Mailing Address - Phone:401-285-2319
Mailing Address - Fax:401-441-6519
Practice Address - Street 1:100 LAFAYETTE ST UNIT 303
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6008
Practice Address - Country:US
Practice Address - Phone:401-285-2319
Practice Address - Fax:401-441-6519
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162671041C0700X
RIISW023481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309161Medicaid