Provider Demographics
NPI:1922179332
Name:DARRISAW, ERICA YVETTE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:YVETTE
Last Name:DARRISAW
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:Y
Other - Last Name:DARRISAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:1600 WIND WILLOW WAY APT 14
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-6099
Mailing Address - Country:US
Mailing Address - Phone:585-664-6563
Mailing Address - Fax:
Practice Address - Street 1:1600 WIND WILLOW WAY APT 14
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6099
Practice Address - Country:US
Practice Address - Phone:585-664-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0592401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical