Provider Demographics
NPI:1972767085
Name:FONTANA, ERIKA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 POE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2527
Mailing Address - Country:US
Mailing Address - Phone:937-276-3356
Mailing Address - Fax:937-276-9514
Practice Address - Street 1:6500 POE AVE STE 400
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2527
Practice Address - Country:US
Practice Address - Phone:937-276-3356
Practice Address - Fax:937-276-9514
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18009431041C0700X
UT6260750-35011041C0700X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty