Healthcare Provider Details

I. General information

NPI: 1750479481
Provider Name (Legal Business Name): ERICA GRACE AHLERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/18/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 WHITNEY AVE STE 303
NEW HAVEN CT
06511-2364
US

IV. Provider business mailing address

357 WHITNEY AVE STE 303
NEW HAVEN CT
06511-2364
US

V. Phone/Fax

Practice location:
  • Phone: 203-773-1988
  • Fax: 203-773-1988
Mailing address:
  • Phone: 203-773-1988
  • Fax: 203-773-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number28731
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number043580
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number043580
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: