Provider Demographics
NPI:1487310520
Name:DESHPANDE, ERICA (PSYD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OTROBANDO AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2116
Mailing Address - Country:US
Mailing Address - Phone:860-889-7274
Mailing Address - Fax:860-889-2131
Practice Address - Street 1:150 OTROBANDO AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2116
Practice Address - Country:US
Practice Address - Phone:860-889-7277
Practice Address - Fax:860-889-2131
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11766103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program