Provider Demographics
NPI:1750597910
Name:ERCKERT, IRENE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:MARIE
Last Name:ERCKERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1945
Mailing Address - Country:US
Mailing Address - Phone:215-817-2291
Mailing Address - Fax:
Practice Address - Street 1:444 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1945
Practice Address - Country:US
Practice Address - Phone:215-817-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007917L103T00000X
NJ3773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA047949Medicare PIN