Individual
TIMOTHY M ERICSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LADC
Contact information
Practice address
4 DANE ST, KENNEBUNK, ME 04043-7054
(207) 985-4211
Mailing address
95 PARKER ST, NEWBURYPORT, MA 01950-4033
(207) 985-4211
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC683
ME
1041C0700X
Clinical Social Worker
Primary
LC2045
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007005
ANTHEM BLUE CROSS
ME
Enumeration date
07/17/2006
Last updated
09/21/2011
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