Provider Demographics
NPI:1003363714
Name:PEPOSE, ERICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:PEPOSE
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 1:401A S VAN BRUNT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4600
Mailing Address - Country:US
Mailing Address - Phone:201-894-9011
Mailing Address - Fax:201-894-9022
Practice Address - Street 1:401A S VAN BRUNT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4600
Practice Address - Country:US
Practice Address - Phone:201-894-9011
Practice Address - Fax:201-894-9022
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00567200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist