Provider Demographics
NPI:1487892733
Name:GERRITY, ERICA ELIZABETH (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:ELIZABETH
Last Name:GERRITY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ELIZABETH
Other - Last Name:DAHLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:447 MARNIE ST S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-6756
Mailing Address - Country:US
Mailing Address - Phone:612-390-5235
Mailing Address - Fax:
Practice Address - Street 1:3450 OLEARY LN
Practice Address - Street 2:MN MENTAL HEALTH CLINICS
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2340
Practice Address - Country:US
Practice Address - Phone:651-365-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical