Provider Demographics
NPI:1285929968
Name:ERICKSON, DEBORAH KAY (LICSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1411
Mailing Address - Country:US
Mailing Address - Phone:651-485-1025
Mailing Address - Fax:651-925-0042
Practice Address - Street 1:2151 HAMLINE AVE N STE 204
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4226
Practice Address - Country:US
Practice Address - Phone:651-800-1127
Practice Address - Fax:651-925-0042
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical