Provider Demographics
NPI:1013308782
Name:ANDERSEN, ERIN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 3RD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4515
Mailing Address - Country:US
Mailing Address - Phone:707-596-0494
Mailing Address - Fax:707-595-5765
Practice Address - Street 1:865 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4519
Practice Address - Country:US
Practice Address - Phone:707-596-0494
Practice Address - Fax:707-595-5765
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC83687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist