Provider Demographics
NPI:1891529582
Name:TICE, ERICA J (LICENSED ESTHETICIAN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:TICE
Suffix:
Gender:F
Credentials:LICENSED ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1311
Mailing Address - Country:US
Mailing Address - Phone:518-439-7960
Mailing Address - Fax:
Practice Address - Street 1:190 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1311
Practice Address - Country:US
Practice Address - Phone:518-439-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAEB-23-00163247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other