Provider Demographics
NPI:1598902348
Name:ERICKSON, SARAH J (PSYD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:ERICKSON
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 1:6A SOUTH ST
Mailing Address - Street 2:PO BOX 233
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01012-9719
Mailing Address - Country:US
Mailing Address - Phone:612-432-3526
Mailing Address - Fax:
Practice Address - Street 1:1985 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1095
Practice Address - Country:US
Practice Address - Phone:612-432-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical