Provider Demographics
NPI:1417425729
Name:ROLDAN, ERICA BRITTNI (LMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:BRITTNI
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 FOUNTAIN AVE APT 37
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1843
Mailing Address - Country:US
Mailing Address - Phone:631-374-7636
Mailing Address - Fax:
Practice Address - Street 1:7609 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2633
Practice Address - Country:US
Practice Address - Phone:423-777-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104701104100000X
TNLSW0000013287104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker