Provider Demographics
NPI:1548301096
Name:DI FATE, ERIN TIBERIO (LCSW PIP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:TIBERIO
Last Name:DI FATE
Suffix:
Gender:F
Credentials:LCSW PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 ROPER LN
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5274
Mailing Address - Country:US
Mailing Address - Phone:251-378-6608
Mailing Address - Fax:
Practice Address - Street 1:7400 ROPER LN
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5274
Practice Address - Country:US
Practice Address - Phone:251-378-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2453C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical