Provider Demographics
NPI:1326469503
Name:ERRICSON, RONNIE
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:ERRICSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MANHEIM AVE
Mailing Address - Street 2:SUITE 10 & 12
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2139
Mailing Address - Country:US
Mailing Address - Phone:856-537-2310
Mailing Address - Fax:856-451-2490
Practice Address - Street 1:105 MANHEIM AVE
Practice Address - Street 2:SUITE 10 & 12
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2139
Practice Address - Country:US
Practice Address - Phone:856-537-2310
Practice Address - Fax:856-451-2490
Is Sole Proprietor?:No
Enumeration Date:2013-12-14
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health