Provider Demographics
NPI:1831146075
Name:SUFRIN, ERICA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MARIE
Last Name:SUFRIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-9713
Mailing Address - Country:US
Mailing Address - Phone:518-439-6997
Mailing Address - Fax:518-765-3058
Practice Address - Street 1:785 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-9713
Practice Address - Country:US
Practice Address - Phone:518-439-6997
Practice Address - Fax:518-765-3058
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53988BMedicare ID - Type Unspecified