Provider Demographics
NPI:1891843165
Name:DEMELLO-ERICKSON, ADRIANA (MSW,LICSW)
Entity Type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:
Last Name:DEMELLO-ERICKSON
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 1:44 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4101
Mailing Address - Country:US
Mailing Address - Phone:401-831-5120
Mailing Address - Fax:
Practice Address - Street 1:444 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4445
Practice Address - Country:US
Practice Address - Phone:401-831-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW005201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3656-8OtherBLUE CROSS BLUE SHIELD