Provider Demographics
NPI:1093181414
Name:PERRY, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PERRY
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-0052
Mailing Address - Country:US
Mailing Address - Phone:508-241-4248
Mailing Address - Fax:978-560-0096
Practice Address - Street 1:1161 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1222
Practice Address - Country:US
Practice Address - Phone:508-241-4248
Practice Address - Fax:978-560-0096
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282572363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health