Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY4438 | CA |
Y | 103G00000X | Clinical Psychologist | PSY4438 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY4438 | CA |
NPI | 1043438500 |
---|---|
Provider Name | Dr. Michael R Erickson |
First Address | Sacramento, CA 95825-6205 |
Second Address | Sacramento, CA 95825-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 19/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170880600 | (02) | CA |