Provider Demographics
NPI:1326138157
Name:HETZER, ERRIC LEIF (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:ERRIC
Middle Name:LEIF
Last Name:HETZER
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 S MAIN ST
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3978
Mailing Address - Country:US
Mailing Address - Phone:410-459-3441
Mailing Address - Fax:
Practice Address - Street 1:336 S MAIN ST
Practice Address - Street 2:SUITE 1-C
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3978
Practice Address - Country:US
Practice Address - Phone:410-459-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG116581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS248OtherMEDICARE