Provider Demographics
NPI:1811097439
Name:VON VILLAS, ERICA
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:VON VILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:VON VILLAS
Other - Last Name:LUNDRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 CAROLE DR
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-3120
Mailing Address - Country:US
Mailing Address - Phone:401-431-9870
Mailing Address - Fax:
Practice Address - Street 1:610 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1504
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:401-438-1957
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01578104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411846OtherBLUE CHIP
RIEV62503Medicaid
RI27560-2OtherBLUE CROSS