Provider Demographics
NPI:1023366333
Name:JAGDEO, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:JAGDEO
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 1:60 OCEANA DR W PH 1D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6664
Mailing Address - Country:US
Mailing Address - Phone:646-529-2801
Mailing Address - Fax:
Practice Address - Street 1:60 OCEANA DR W PH 1D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6664
Practice Address - Country:US
Practice Address - Phone:646-529-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst