Provider Demographics
NPI:1689396608
Name:ERIN SLATTERY, LICENSED CLINICAL SOCIAL WORKER, PC CORP
Entity Type:Organization
Organization Name:ERIN SLATTERY, LICENSED CLINICAL SOCIAL WORKER, PC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-312-1845
Mailing Address - Street 1:8666 BLYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662
Mailing Address - Country:US
Mailing Address - Phone:916-312-1845
Mailing Address - Fax:
Practice Address - Street 1:8666 BLYTHE AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662
Practice Address - Country:US
Practice Address - Phone:916-312-1845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health