Provider Demographics
NPI:1275386393
Name:MBASAN, ERICA LYNN (MHC-LP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYNN
Last Name:MBASAN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HERBERT ST
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2810
Mailing Address - Country:US
Mailing Address - Phone:845-591-1049
Mailing Address - Fax:
Practice Address - Street 1:2 HERBERT ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2810
Practice Address - Country:US
Practice Address - Phone:845-591-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health