Provider Demographics
NPI:1528617131
Name:NEUFELD, ERICA (LCAT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:NEUFELD
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:ROSSETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAT
Mailing Address - Street 1:31 THURBER DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1665
Mailing Address - Country:US
Mailing Address - Phone:315-539-1980
Mailing Address - Fax:
Practice Address - Street 1:96 STARK ST # 8807
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-8807
Practice Address - Country:US
Practice Address - Phone:315-539-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001707221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist