Provider Demographics
NPI:1023239795
Name:ERLIJ, ANTONIETA (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANTONIETA
Middle Name:
Last Name:ERLIJ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAMBRIDGE YOUTH GUIDANCE CENTER
Mailing Address - Street 2:5 SACRAMENTO STREET
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-354-2275
Mailing Address - Fax:617-547-4356
Practice Address - Street 1:CAMBRIDGE YOUTH GUIDANCE CENTER
Practice Address - Street 2:5 SACRAMENTO STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-354-2275
Practice Address - Fax:617-547-4356
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023308104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker