Provider Demographics
NPI:1033997192
Name:ELLIE MENTAL HEALTH AT THE JERSEY SHORE LLC
Entity Type:Organization
Organization Name:ELLIE MENTAL HEALTH AT THE JERSEY SHORE LLC
Other - Org Name:ELLIE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LCADC ACS CCS
Authorized Official - Phone:732-814-9401
Mailing Address - Street 1:1350 CAMPUS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6821
Mailing Address - Country:US
Mailing Address - Phone:732-924-5589
Mailing Address - Fax:
Practice Address - Street 1:1350 CAMPUS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6821
Practice Address - Country:US
Practice Address - Phone:732-924-5589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty