Provider Demographics
NPI:1811051063
Name:PRICE, ERIN FARICY (LICSW MSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:FARICY
Last Name:PRICE
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 YORK AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2334
Mailing Address - Country:US
Mailing Address - Phone:952-374-9110
Mailing Address - Fax:952-500-9281
Practice Address - Street 1:6550 YORK AVE S STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-374-9100
Practice Address - Fax:952-500-9281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN897967700Medicaid