Provider Demographics
NPI:1346301199
Name:ERICKSON, JANET WENTWORTH (LCSW-R CASAC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:WENTWORTH
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LCSW-R CASAC
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:LOUISE
Other - Last Name:WENTWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R CASAC
Mailing Address - Street 1:665 W KORTRIGHT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEREDITH
Mailing Address - State:NY
Mailing Address - Zip Code:13757-1055
Mailing Address - Country:US
Mailing Address - Phone:607-278-5784
Mailing Address - Fax:
Practice Address - Street 1:242 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2527
Practice Address - Country:US
Practice Address - Phone:607-431-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078760-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical