Provider Demographics
NPI:1033723135
Name:BOSTIC, ERICA (MSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MILL SPGS
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:IN
Mailing Address - Zip Code:46128-9386
Mailing Address - Country:US
Mailing Address - Phone:812-447-3063
Mailing Address - Fax:
Practice Address - Street 1:308 MEDIC WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2296
Practice Address - Country:US
Practice Address - Phone:765-653-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker