Provider Demographics
NPI:1053447854
Name:BALTEZORE, ERICA LUCILLE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LUCILLE
Last Name:BALTEZORE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:707-343-1100
Mailing Address - Fax:530-924-2036
Practice Address - Street 1:756 EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:707-343-1100
Practice Address - Fax:530-924-2036
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51131106H00000X
CALMFT96971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist