Provider Demographics
NPI:1750341558
Name:EHRENSHAFT, MARK (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:EHRENSHAFT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 GALT OCEAN DRIVE
Mailing Address - Street 2:# 1802
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6847
Mailing Address - Country:US
Mailing Address - Phone:954-566-6936
Mailing Address - Fax:954-583-9575
Practice Address - Street 1:6950 CYPRESS ROAD
Practice Address - Street 2:SUITE # 103-A
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2360
Practice Address - Country:US
Practice Address - Phone:954-583-8831
Practice Address - Fax:954-583-9575
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0002186104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical