Provider Demographics
NPI:1407113046
Name:GITTLEMAN, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GITTLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:GITTLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 NEWGATE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1857
Mailing Address - Country:US
Mailing Address - Phone:860-402-1888
Mailing Address - Fax:
Practice Address - Street 1:8 NEWGATE ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1857
Practice Address - Country:US
Practice Address - Phone:860-402-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-12-10350103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst