Provider Demographics
NPI:1306867817
Name:ERICKSON, JUDITH M (PHD, CNS, BC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PHD, CNS, BC
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:E
Other - Last Name:FORKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CNS
Mailing Address - Street 1:110 MCKEEL AVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3426
Mailing Address - Country:US
Mailing Address - Phone:914-806-3267
Mailing Address - Fax:
Practice Address - Street 1:239 N BROADWAY STE 6
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2654
Practice Address - Country:US
Practice Address - Phone:149-806-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212563-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR48701Medicare ID - Type UnspecifiedCLINICAL NURSE SPECIALIST