Provider Demographics
NPI:1245900240
Name:BUFFINGTON, ERICA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1611
Mailing Address - Country:US
Mailing Address - Phone:815-762-0782
Mailing Address - Fax:
Practice Address - Street 1:417 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1611
Practice Address - Country:US
Practice Address - Phone:815-762-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker