Basic Information
| Provider Information | |||||||||
| NPI: | 1063160729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINKLEY | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GILMAN | ||||||||
| OtherFirstName: | ERICA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
| FaxNumber: | 4139679807 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
| FaxNumber: | 4139679807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2022 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.