Provider Demographics
NPI:1366635872
Name:ERICKSON, DONNA M
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1037
Mailing Address - Country:US
Mailing Address - Phone:631-790-9796
Mailing Address - Fax:
Practice Address - Street 1:43 OLIVER ST
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1037
Practice Address - Country:US
Practice Address - Phone:631-790-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1942438OtherSTUDENTS WITH DISABILITIE