Provider Demographics
NPI:1982905840
Name:STAPLES, ERICA (LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:STAPLES
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 1:54 POORS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MORRILL
Mailing Address - State:ME
Mailing Address - Zip Code:04952-5130
Mailing Address - Country:US
Mailing Address - Phone:207-930-9524
Mailing Address - Fax:
Practice Address - Street 1:54 POORS MILL RD
Practice Address - Street 2:
Practice Address - City:MORRILL
Practice Address - State:ME
Practice Address - Zip Code:04952-5130
Practice Address - Country:US
Practice Address - Phone:207-323-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC135451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical