Provider Demographics
NPI:1114326394
Name:KAPILOFF, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KAPILOFF
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 1:15 SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9401
Mailing Address - Country:US
Mailing Address - Phone:860-651-8707
Mailing Address - Fax:
Practice Address - Street 1:15 SPRUCE LN
Practice Address - Street 2:
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9401
Practice Address - Country:US
Practice Address - Phone:860-651-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060653062Medicaid