Provider Demographics
NPI:1639887649
Name:TETI, ERICA LAUREL (LMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LAUREL
Last Name:TETI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PINE ST APT 616
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5881
Mailing Address - Country:US
Mailing Address - Phone:860-992-8018
Mailing Address - Fax:
Practice Address - Street 1:16 BRACE RD FL 3
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1825
Practice Address - Country:US
Practice Address - Phone:860-992-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty