Provider Demographics
NPI:1144673120
Name:MOON, ERIN NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:MOON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 SEMINOLE CENTRE CT STE 120
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5019
Mailing Address - Country:US
Mailing Address - Phone:844-467-3467
Mailing Address - Fax:
Practice Address - Street 1:5944 SEMINOLE CENTRE CT STE 210
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5019
Practice Address - Country:US
Practice Address - Phone:844-467-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130183-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker