Provider Demographics
NPI:1770788598
Name:ERRICO, AUSTIN LOUIS (PHD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:LOUIS
Last Name:ERRICO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CUNNINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6312
Mailing Address - Country:US
Mailing Address - Phone:207-809-9007
Mailing Address - Fax:207-865-9910
Practice Address - Street 1:45 CUNNINGHAM RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6312
Practice Address - Country:US
Practice Address - Phone:207-809-9007
Practice Address - Fax:207-865-9910
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS970103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH043837OtherBLUE CROSS BLUE SHIELD
NH30423759Medicaid
NH043837OtherBLUE CROSS BLUE SHIELD