Provider Demographics
NPI:1548418379
Name:EHRLICH, ELLEN (EDD, RN PSYA)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:EDD, RN PSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FAESCH CT
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4814
Mailing Address - Country:US
Mailing Address - Phone:973-328-1065
Mailing Address - Fax:
Practice Address - Street 1:22 FAESCH CT
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4814
Practice Address - Country:US
Practice Address - Phone:973-328-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098 0000225102L00000X
NJ26NR02549100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst