Provider Demographics
NPI:1154573053
Name:ERLICH, DAVID (LCSW & LISAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:ERLICH
Suffix:
Gender:M
Credentials:LCSW & LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4112
Mailing Address - Country:US
Mailing Address - Phone:520-876-5764
Mailing Address - Fax:520-876-5613
Practice Address - Street 1:413 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4112
Practice Address - Country:US
Practice Address - Phone:520-876-5764
Practice Address - Fax:520-876-5613
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11736101YA0400X
AZ120711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid