Provider Demographics
NPI:1497851182
Name:ERAZO-UPTON, ANITA (PHD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:ERAZO-UPTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:ERAZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:401 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3628
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:
Practice Address - Street 1:401 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3628
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH020258994-29OtherHARVARD PILGRIM
NH0602482Y0NH01OtherBLUE CROSS
NH1052497OtherCIGNA
NH0602482Y0NH01OtherBLUE CROSS