Provider Demographics
NPI:1841541133
Name:PARADIS, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PARADIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 RADCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4615
Mailing Address - Country:US
Mailing Address - Phone:757-613-2235
Mailing Address - Fax:
Practice Address - Street 1:5105 RADCLIFF CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4615
Practice Address - Country:US
Practice Address - Phone:757-613-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service