Provider Demographics
NPI:1396413662
Name:NATALICCHIO, ERICA (MED, LGPC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:NATALICCHIO
Suffix:
Gender:F
Credentials:MED, LGPC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8229 CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1538
Practice Address - Country:US
Practice Address - Phone:732-513-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional