Provider Demographics
NPI:1477829711
Name:THOMAS, ERICA JEANINE (PSYD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JEANINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 W. NORTH AVENUE
Mailing Address - Street 2:SUITE 303-A
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:877-807-5120
Mailing Address - Fax:708-460-4120
Practice Address - Street 1:1440 W NORTH AVE
Practice Address - Street 2:SUITE 303-A
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1422
Practice Address - Country:US
Practice Address - Phone:877-807-5120
Practice Address - Fax:708-460-4120
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical