Provider Demographics
NPI:1952345092
Name:EHRENREICH, JOHN H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:EHRENREICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HOLIDAY POINT RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-1624
Mailing Address - Country:US
Mailing Address - Phone:860-355-2539
Mailing Address - Fax:860-350-6658
Practice Address - Street 1:19 HOLIDAY POINT RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:CT
Practice Address - Zip Code:06784-1624
Practice Address - Country:US
Practice Address - Phone:860-355-2539
Practice Address - Fax:860-350-6658
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001616103TC0700X
NY010365-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
680000108Medicare PIN