Healthcare Provider Details

I. General information

NPI: 1548418379
Provider Name (Legal Business Name): ELLEN EHRLICH ED.D, RN PSYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 FAESCH CT
ROCKAWAY NJ
07866-4814
US

IV. Provider business mailing address

22 FAESCH CT
ROCKAWAY NJ
07866-4814
US

V. Phone/Fax

Practice location:
  • Phone: 973-328-1065
  • Fax:
Mailing address:
  • Phone: 973-328-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number098 0000225
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR02549100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: