Provider Demographics
NPI:1467064642
Name:BRAZEE, ERIKA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:
Last Name:BRAZEE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PATRIOTS LN
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03290-5821
Mailing Address - Country:US
Mailing Address - Phone:603-393-4915
Mailing Address - Fax:
Practice Address - Street 1:2 PATRIOTS LN
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:NH
Practice Address - Zip Code:03290-5821
Practice Address - Country:US
Practice Address - Phone:603-393-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH96247103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool