MEDICARE: DR. ERICA GRACE AHLERT MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	28731	SC
2	2084P0804X	Child & Adolescent Psychiatry Physician	043580	CT
3	2084P0800X	Psychiatry Physician	043580	CT

General Provider Information

NPI Number	:	1750479481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA GRACE AHLERT MD

Provider Business Mailing Address
First Line	:	357 WHITNEY AVE STE 303
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-2364
Country	:	US
Telephone Number	:	203-773-1988
Fax Number	:	203-773-1988

Provider Business Practice Location Address
First Line	:	357 WHITNEY AVE STE 303
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-2364
Country	:	US
Telephone Number	:	203-773-1988
Fax Number	:	203-773-1988

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	11/18/2023

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