Provider Demographics
NPI:1902147622
Name:BOWER, ERICA YVONNE (MS ED LPC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:YVONNE
Last Name:BOWER
Suffix:
Gender:F
Credentials:MS ED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ECHO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5909
Mailing Address - Country:US
Mailing Address - Phone:570-772-5140
Mailing Address - Fax:860-969-4551
Practice Address - Street 1:131 ECHO RIDGE DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5909
Practice Address - Country:US
Practice Address - Phone:570-772-5140
Practice Address - Fax:860-969-4551
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional