Provider Demographics
NPI:1427710664
Name:LIDDIL, ERICA LORRAINE (LP-MFT)
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LORRAINE
Last Name:LIDDIL
Suffix:
Gender:F
Credentials:LP-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 SPRUCE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9661
Mailing Address - Country:US
Mailing Address - Phone:315-692-4770
Mailing Address - Fax:
Practice Address - Street 1:6700 KIRKVILLE RD STE 103B
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9373
Practice Address - Country:US
Practice Address - Phone:315-492-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist