Provider Demographics
NPI:1154671618
Name:ERIKA BRONSTEIN M S W P S
Entity Type:Organization
Organization Name:ERIKA BRONSTEIN M S W P S
Other - Org Name:ERIKA BRONTSEIN, MSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:LADNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-734-5471
Mailing Address - Street 1:1715 C ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4016
Mailing Address - Country:US
Mailing Address - Phone:360-734-5071
Mailing Address - Fax:360-676-2754
Practice Address - Street 1:1715 C ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4016
Practice Address - Country:US
Practice Address - Phone:360-734-5071
Practice Address - Fax:360-676-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000059181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB21031Medicare UPIN