Provider Demographics
NPI:1326682824
Name:EHRENBERG, CARIN LEVINE (PHD)
Entity Type:Individual
Prefix:
First Name:CARIN
Middle Name:LEVINE
Last Name:EHRENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CARIN
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:323 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2891
Mailing Address - Country:US
Mailing Address - Phone:917-743-1222
Mailing Address - Fax:
Practice Address - Street 1:275 7TH AVE RM 2501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-8400
Practice Address - Country:US
Practice Address - Phone:917-743-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013647-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013647-1OtherNEW YORK STATE