Provider Demographics
NPI:1629336763
Name:EHRENBERG, EDWARD JAMES (MSW,LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JAMES
Last Name:EHRENBERG
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIERSON MILLER DR
Mailing Address - Street 2:D-52
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1045
Mailing Address - Country:US
Mailing Address - Phone:862-228-0136
Mailing Address - Fax:
Practice Address - Street 1:100 PIERSON MILLER DR
Practice Address - Street 2:D-52
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1045
Practice Address - Country:US
Practice Address - Phone:862-228-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05459800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker