Provider Demographics
NPI:1710289186
Name:PROCACCI, ERIN NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:NICOLE
Last Name:PROCACCI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 E SUNRISE BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1479
Mailing Address - Country:US
Mailing Address - Phone:954-399-1680
Mailing Address - Fax:
Practice Address - Street 1:1948 E SUNRISE BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1479
Practice Address - Country:US
Practice Address - Phone:954-399-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7990103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist