Provider Demographics
NPI:1295858587
Name:EHRHARDT, CHARLES FREDRIC (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FREDRIC
Last Name:EHRHARDT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W 10TH ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8765
Mailing Address - Country:US
Mailing Address - Phone:212-677-7149
Mailing Address - Fax:212-674-8628
Practice Address - Street 1:60 W 10TH ST
Practice Address - Street 2:SUITE 6B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8765
Practice Address - Country:US
Practice Address - Phone:212-677-7149
Practice Address - Fax:212-674-8628
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0261241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDO3983OtherOXFORD HEALTH PLANS
NY62-72353OtherUNITED BEHAVIORAL HEALTH