Provider Demographics
NPI:1396315255
Name:KASPER, ERIK W (SC2859)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:W
Last Name:KASPER
Suffix:
Gender:M
Credentials:SC2859
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29200 CORBIN PKWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4830
Mailing Address - Country:US
Mailing Address - Phone:631-335-8372
Mailing Address - Fax:
Practice Address - Street 1:202 COURSEVALL DR STE 104
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2805
Practice Address - Country:US
Practice Address - Phone:443-262-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC2895101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)