Provider Demographics
NPI:1811637374
Name:PAGE, ERICA LEA (LCSWI)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEA
Last Name:PAGE
Suffix:
Gender:F
Credentials:LCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5069
Mailing Address - Country:US
Mailing Address - Phone:850-226-7666
Mailing Address - Fax:850-226-7499
Practice Address - Street 1:3 VINE AVE NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5069
Practice Address - Country:US
Practice Address - Phone:850-226-7666
Practice Address - Fax:850-226-7499
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW216031041C0700X
FLISW159751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL851171102OtherSTATE OF FLORIDA