Provider Demographics
NPI:1992471130
Name:EHRLICH, MARC I (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:I
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FUENTE DE ETIOPIA #27
Mailing Address - Street 2:
Mailing Address - City:LOMAS DE TECAMACHALCO
Mailing Address - State:HUIXQUILUCAN
Mailing Address - Zip Code:52780
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FUENTE DE ETIOPIA 27
Practice Address - Street 2:LOMAS DE TECAMACHALCO
Practice Address - City:HUIXQUILUCAN
Practice Address - State:ESTADO DE MEXICO
Practice Address - Zip Code:52780
Practice Address - Country:MX
Practice Address - Phone:559-199-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical