Provider Demographics
NPI:1417119256
Name:ANTONIO, ERICA STROEH (MFT)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:STROEH
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 SUTRO AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-1935
Mailing Address - Country:US
Mailing Address - Phone:415-892-8252
Mailing Address - Fax:
Practice Address - Street 1:300 SUNNYHILLS DR
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1909
Practice Address - Country:US
Practice Address - Phone:415-720-3372
Practice Address - Fax:415-785-3283
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 80062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist