Provider Demographics
NPI:1972701522
Name:JANSON, ERICA LAUREN (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LAUREN
Last Name:JANSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RIO DEL NORTE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-4862
Mailing Address - Country:US
Mailing Address - Phone:860-539-3651
Mailing Address - Fax:
Practice Address - Street 1:6058 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2358
Practice Address - Country:US
Practice Address - Phone:860-539-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical