Provider Demographics
NPI:1003096314
Name:ROSS, ERIKA
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01342-0195
Mailing Address - Country:US
Mailing Address - Phone:413-824-2249
Mailing Address - Fax:
Practice Address - Street 1:22 GREENOUGH CROSSING RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01342-9703
Practice Address - Country:US
Practice Address - Phone:413-824-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MA1486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist