Provider Demographics
NPI:1851090914
Name:MEAD, ERIC LEE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:MEAD
Suffix:
Gender:M
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 1:1564 COUNTY ROAD 134
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0346
Mailing Address - Country:US
Mailing Address - Phone:320-229-5199
Mailing Address - Fax:
Practice Address - Street 1:1564 COUNTY ROAD 134
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-0346
Practice Address - Country:US
Practice Address - Phone:320-229-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN271771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical