Provider Demographics
NPI:1750509287
Name:GAIL P ERICSON, LCSW
Entity Type:Organization
Organization Name:GAIL P ERICSON, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:PAULA
Authorized Official - Last Name:ERICSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-753-1211
Mailing Address - Street 1:4119 E CATHEDRAL ROCK DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3707
Mailing Address - Country:US
Mailing Address - Phone:480-518-5550
Mailing Address - Fax:
Practice Address - Street 1:11022 S 51ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4308
Practice Address - Country:US
Practice Address - Phone:480-753-1211
Practice Address - Fax:480-753-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-20091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty