Provider Demographics
NPI:1972773455
Name:ERICKSON, MARTI LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARTI
Middle Name:LOUISE
Last Name:ERICKSON
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 1:1934 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1755
Mailing Address - Country:US
Mailing Address - Phone:650-592-5039
Mailing Address - Fax:650-591-2495
Practice Address - Street 1:1209 EATON AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5234
Practice Address - Country:US
Practice Address - Phone:650-592-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 28383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist