Provider Demographics
NPI:1922819481
Name:MYRICK, ERIC A
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:MYRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-1525
Mailing Address - Country:US
Mailing Address - Phone:908-296-0623
Mailing Address - Fax:
Practice Address - Street 1:1001 LINCOLN BLVD STE C
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-2566
Practice Address - Country:US
Practice Address - Phone:908-296-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00974800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health