Provider Demographics
NPI:1679142863
Name:HERTRICH, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HERTRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EAGLE ROCK AVE UNIT 64
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-6603
Mailing Address - Country:US
Mailing Address - Phone:347-351-6076
Mailing Address - Fax:
Practice Address - Street 1:209 NEW FREEDOM RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-2803
Practice Address - Country:US
Practice Address - Phone:347-351-6076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL066705001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical