Provider Demographics
NPI:1245825173
Name:STORM, ERIN MARGARET (LMSW, MDIV)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARGARET
Last Name:STORM
Suffix:
Gender:F
Credentials:LMSW, MDIV
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARGARET
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:100 E NORMAL AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4200
Mailing Address - Country:US
Mailing Address - Phone:660-785-4182
Mailing Address - Fax:660-785-4011
Practice Address - Street 1:100 E NORMAL AVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4200
Practice Address - Country:US
Practice Address - Phone:660-785-4182
Practice Address - Fax:660-785-4011
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045074104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker