Provider Demographics
NPI:1508463829
Name:CARRERA, ERICK
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:CARRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NEWBURG RD STE B
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2599
Mailing Address - Country:US
Mailing Address - Phone:707-600-6815
Mailing Address - Fax:
Practice Address - Street 1:3000 NEWBURG RD STE B
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2599
Practice Address - Country:US
Practice Address - Phone:707-600-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT148952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist