Provider Demographics
NPI:1326302696
Name:HAGGERTY, ERIKA (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ERIKA
Other - Middle Name:TERESA
Other - Last Name:JARMOLOWICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8975 S EASTERN AVE
Mailing Address - Street 2:C-3
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5741
Mailing Address - Country:US
Mailing Address - Phone:702-541-7800
Mailing Address - Fax:
Practice Address - Street 1:8685 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2839
Practice Address - Country:US
Practice Address - Phone:702-754-0807
Practice Address - Fax:702-754-0808
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 225400000X
NV7455-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1326302696Medicaid