Provider Demographics
NPI:1902014350
Name:SCHRAMM, ERICA ROSE (LISW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ROSE
Last Name:SCHRAMM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ROSE
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:307 LA CUESTA AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3759
Mailing Address - Country:US
Mailing Address - Phone:505-215-3965
Mailing Address - Fax:
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-324-5834
Practice Address - Fax:505-324-5896
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-065011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical