Provider Demographics
NPI:1295094944
Name:LEBRON, ERIKA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE LA FABRICA 183
Mailing Address - Street 2:BO COQUI AGUIRRE
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00704
Mailing Address - Country:US
Mailing Address - Phone:787-344-8697
Mailing Address - Fax:
Practice Address - Street 1:85 SAINT GEORGE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3333
Practice Address - Country:US
Practice Address - Phone:413-732-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PR110061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295Medicaid
MA042622756OtherCOMMONWEALTH
MA1303295OtherMBHP
MA8443OtherBMC
MA997303OtherNETWORK HEALTH
MA1022610OtherBEACON