Provider Demographics
NPI:1679753255
Name:ERLICH-PENCHUK, SARA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:ERLICH-PENCHUK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5652
Mailing Address - Country:US
Mailing Address - Phone:201-833-9434
Mailing Address - Fax:
Practice Address - Street 1:154 BENNETT RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5652
Practice Address - Country:US
Practice Address - Phone:201-833-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640844Medicare PIN