Provider Demographics
NPI:1881235851
Name:NARDELLA, ERICA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:NARDELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 S KOBUK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5127
Mailing Address - Country:US
Mailing Address - Phone:907-699-7907
Mailing Address - Fax:
Practice Address - Street 1:2935 S KOBUK AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5127
Practice Address - Country:US
Practice Address - Phone:907-699-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1845521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2771Medicaid