Provider Demographics
NPI:1104383116
Name:DENNER, ERICA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:DENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43745 STINE RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13679-4153
Mailing Address - Country:US
Mailing Address - Phone:315-771-0018
Mailing Address - Fax:
Practice Address - Street 1:4 FULLER ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607-1316
Practice Address - Country:US
Practice Address - Phone:315-482-1277
Practice Address - Fax:315-482-4911
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093219-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker