Provider Demographics
NPI:1760803100
Name:KANE, ERICA D (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:D
Last Name:KANE
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4507
Mailing Address - Country:US
Mailing Address - Phone:765-388-2671
Mailing Address - Fax:888-441-0850
Practice Address - Street 1:200 N 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4507
Practice Address - Country:US
Practice Address - Phone:765-388-2671
Practice Address - Fax:888-441-0850
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042765A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201285970AMedicaid