Provider Demographics
NPI:1972231397
Name:ERICKSON, ATHENA CHRISTINE
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:CHRISTINE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DUNCANNON AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-5121
Mailing Address - Country:US
Mailing Address - Phone:508-265-2252
Mailing Address - Fax:
Practice Address - Street 1:JONAS CLARK HALL, 3RD FLOOR
Practice Address - Street 2:950 MAIN STREET
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-265-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program