Provider Demographics
NPI:1679753255
Name:ERLICH PENCHUK, SARA (LCSW)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:ERLICH PENCHUK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 STERLING BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4839
Mailing Address - Country:US
Mailing Address - Phone:201-833-9434
Mailing Address - Fax:
Practice Address - Street 1:75 STERLING BLVD APT 302
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4839
Practice Address - Country:US
Practice Address - Phone:201-833-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC0018160001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640844Medicare PIN