Provider Demographics
NPI:1083925515
Name:HUMBAUGH, ERIN (BC-DMT, LCAT, NCC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HUMBAUGH
Suffix:
Gender:F
Credentials:BC-DMT, LCAT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 CENTER BLVD
Mailing Address - Street 2:1514
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5740
Mailing Address - Country:US
Mailing Address - Phone:614-571-0279
Mailing Address - Fax:
Practice Address - Street 1:4705 CENTER BLVD
Practice Address - Street 2:1514
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5740
Practice Address - Country:US
Practice Address - Phone:614-571-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000953101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor