MEDICARE: MS. JANICE SUE EHRLICH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS18897	CA

General Provider Information

NPI Number	:	1235287327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE SUE EHRLICH LCSW

Provider Business Mailing Address
First Line	:	12011 SAN VICENTE BLVD
Second Line	:	SUITE 510
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4926
Country	:	US
Telephone Number	:	310-472-1976
Fax Number	:	310-473-6912

Provider Business Practice Location Address
First Line	:	12011 SAN VICENTE BLVD
Second Line	:	SUITE 510
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4926
Country	:	US
Telephone Number	:	310-472-1976
Fax Number	:	310-473-6912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/05/2009

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