Provider Demographics
NPI:1538649074
Name:ERICA L HERNANDEZ, LCSW, LLC
Entity Type:Organization
Organization Name:ERICA L HERNANDEZ, LCSW, LLC
Other - Org Name:ERICA L FREEMAN, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-345-7010
Mailing Address - Street 1:1400 HIGH ST STE C1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4192
Mailing Address - Country:US
Mailing Address - Phone:541-345-7010
Mailing Address - Fax:541-343-1044
Practice Address - Street 1:1400 HIGH ST STE C1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4192
Practice Address - Country:US
Practice Address - Phone:541-345-7010
Practice Address - Fax:541-343-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR36881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR50060860Medicaid