Basic Information
| Provider Information | |||||||||
| NPI: | 1477829711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | JEANINE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 W. NORTH AVENUE | ||||||||
| Address2: | SUITE 303-A | ||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778075120 | ||||||||
| FaxNumber: | 7084604120 | ||||||||
| Practice Location | |||||||||
| Address1: | 1440 W NORTH AVE | ||||||||
| Address2: | SUITE 303-A | ||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601601422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778075120 | ||||||||
| FaxNumber: | 7084604120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2012 | ||||||||
| LastUpdateDate: | 03/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 071008294 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.