Individual provider Active NPI

Erric Leif Hetzer, LCSW-C

  • Clinical Social Worker
  • Bel Air, MD
National Provider Identifier
1326138157
Registry record updated Oct 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
G11658 Issued in MD
Practice address
336 S Main St
Suite 1-C
Bel Air, MD 21014-3978
Phone
(410) 459-3441
NPI assigned
Oct 13, 2006
Last updated
Oct 5, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X G11658 MD Primary

Addresses

Primary practice location

336 S Main St
Suite 1-C
Bel Air, MD 21014-3978

Mailing address

336 S Main St
Suite 1-C
Bel Air, MD 21014-3978
Phone (410) 459-3441

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080321000172 MD Practitioner - Clinical Social Worker 6709962467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oic Counseling Services, Inc.Group PAC ID 3375718950, 8 clinicians

Practice addresses (Care Compare)

336 S Main St
Suite 1C
Bel Air, MD 21014-3978
Phone (410) 836-0820

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
G11658MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Oic Counseling Services, Inc. Clinical Current Accepting new patients
Oic Counseling Services, Inc. CurrentSince Oct 4, 2011 Accepting new patients

Locations

336 S Main St
Ste 1C
Bel Air, MD 21014
Phone (410) 836-0820

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444003200000",
    "number": "1326138157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 S MAIN ST",
            "address_2": "SUITE 1-C",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143978",
            "telephone_number": "410-459-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 S MAIN ST",
            "address_2": "SUITE 1-C",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143978",
            "telephone_number": "410-459-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETZER",
        "first_name": "ERRIC",
        "middle_name": "LEIF",
        "name_prefix": "Mr.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "G11658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

Verify at the official NPI Registry.