Provider Demographics
NPI:1083922991
Name:HEALY, ELLEN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:T
Last Name:HEALY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:T
Other - Last Name:KAHN-GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:WHSD (116B-3)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-4472
Mailing Address - Fax:
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:WHSD (116B-3)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01226261QV0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical