Provider Demographics
NPI:1720457146
Name:EHRLICH, CHARLES (LDS)
Entity Type:Individual
Prefix:PROF
First Name:CHARLES
Middle Name:
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:LDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1512
Mailing Address - Country:US
Mailing Address - Phone:201-967-1436
Mailing Address - Fax:
Practice Address - Street 1:822 5TH AVE
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1512
Practice Address - Country:US
Practice Address - Phone:201-967-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0470728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0470728OtherBUSINESS REGISTRATION CERTIFICATE