Provider Demographics
NPI:1255663928
Name:PETRI, ERIKA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:L
Last Name:PETRI
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 1:9 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1717
Mailing Address - Country:US
Mailing Address - Phone:207-712-5775
Mailing Address - Fax:
Practice Address - Street 1:9 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1717
Practice Address - Country:US
Practice Address - Phone:207-712-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC96471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical