| Organization Name: | ROBERT ERICSON, PHD |
| NPI Number: | 1700069796 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT CHARLES ERICSON (PRESIDENT) |
| Mailing Address: | 6463 4th St Nw Suite C Los Ranchos De Albuquerque |
| State: | NM US |
| Postal Code: | 871075810 |
| Phone Number: | 5053449500 |
| Fax Number: | 5053421084 |
| NPI Enumeration Date: | 12/12/2007 |
| NPI Last Update Date: | 08/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 239 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |