Provider Demographics
NPI:1770647711
Name:SCOPPETTI, ERICA DIANE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:DIANE
Last Name:SCOPPETTI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HEATH ST
Mailing Address - Street 2:WEST 3
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2332
Mailing Address - Country:US
Mailing Address - Phone:617-355-1293
Mailing Address - Fax:
Practice Address - Street 1:400 HEATH ST
Practice Address - Street 2:WEST 3
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2332
Practice Address - Country:US
Practice Address - Phone:617-355-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical