Provider Demographics
NPI:1801261284
Name:BERTOCCHI, ERICA (BSW, MDIV)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BERTOCCHI
Suffix:
Gender:F
Credentials:BSW, MDIV
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:ECKENSBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, MDIV
Mailing Address - Street 1:10 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-1616
Mailing Address - Country:US
Mailing Address - Phone:774-271-0343
Mailing Address - Fax:
Practice Address - Street 1:10 KILBURN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7321
Practice Address - Country:US
Practice Address - Phone:508-979-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPRIMARY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)