Provider Demographics
NPI:1821365255
Name:VERA, ERICA R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:R
Last Name:VERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9407
Mailing Address - Country:US
Mailing Address - Phone:585-223-8333
Mailing Address - Fax:
Practice Address - Street 1:56 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9407
Practice Address - Country:US
Practice Address - Phone:585-223-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720715201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical