Provider Demographics
NPI:1063754331
Name:SOBOLOW, ERICA MORGAN (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:MORGAN
Last Name:SOBOLOW
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E 14TH ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2941
Mailing Address - Country:US
Mailing Address - Phone:718-344-5271
Mailing Address - Fax:
Practice Address - Street 1:2665 BROWN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1603
Practice Address - Country:US
Practice Address - Phone:718-344-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQJ38479XMedicaid