Provider Demographics
NPI:1487380101
Name:PETOSA, ERICA DAWN (MSW)
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:DAWN
Last Name:PETOSA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EVERGREEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST KILL
Mailing Address - State:NY
Mailing Address - Zip Code:12492-5624
Mailing Address - Country:US
Mailing Address - Phone:518-410-8742
Mailing Address - Fax:
Practice Address - Street 1:239 GOLDEN HILL DRIVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-340-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical