Provider Demographics
NPI:1710366976
Name:GONZALEZ CARRILLO, ERICKA (MA)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:GONZALEZ CARRILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1016
Mailing Address - Country:US
Mailing Address - Phone:413-361-4587
Mailing Address - Fax:413-788-0626
Practice Address - Street 1:1985 MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1016
Practice Address - Country:US
Practice Address - Phone:413-361-4587
Practice Address - Fax:413-788-0626
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA18240101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health