Provider Demographics
NPI:1255483004
Name:BACKMANN, ERICA (MA)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:BACKMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-1228
Mailing Address - Country:US
Mailing Address - Phone:860-933-0483
Mailing Address - Fax:
Practice Address - Street 1:1066 STORRS RD STE E
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2648
Practice Address - Country:US
Practice Address - Phone:860-933-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist