Provider Demographics
NPI:1043088420
Name:HOSTETLER, ERICA JOHNSON (LMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JOHNSON
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6266
Mailing Address - Country:US
Mailing Address - Phone:607-342-2570
Mailing Address - Fax:
Practice Address - Street 1:16 CINEMA DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1674
Practice Address - Country:US
Practice Address - Phone:607-364-9179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085872104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker