Provider Demographics
NPI:1093567414
Name:BLAS-MARQUEZ, ERICA OCTAVIA (MSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:OCTAVIA
Last Name:BLAS-MARQUEZ
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 1:36 N MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1129
Mailing Address - Country:US
Mailing Address - Phone:934-216-8349
Mailing Address - Fax:
Practice Address - Street 1:36 N MORRIS AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1129
Practice Address - Country:US
Practice Address - Phone:934-216-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical