Provider Demographics
NPI:1104361476
Name:ERICKSON, ROBIN (MS, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4889 EAST BAKERSFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:ENOSBURG FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05450
Mailing Address - Country:US
Mailing Address - Phone:802-730-4175
Mailing Address - Fax:802-888-6393
Practice Address - Street 1:22 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464-8100
Practice Address - Country:US
Practice Address - Phone:802-730-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT06810057624101YM0800X
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1029302Medicaid