Provider Demographics
NPI:1144436783
Name:PRICE, ESTELLE ELLENBERG (MS)
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:ELLENBERG
Last Name:PRICE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BENJ FRANKLIN PKWY
Mailing Address - Street 2:PARK TOWNE PLACE E105
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130
Mailing Address - Country:US
Mailing Address - Phone:215-988-9301
Mailing Address - Fax:
Practice Address - Street 1:2200 BENJ FRANKLIN PKWY
Practice Address - Street 2:PARK TOWNE PLACE E105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3601
Practice Address - Country:US
Practice Address - Phone:215-988-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007483L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS007483LOtherPSYCHOLOGY LICENSE
S621OtherASSN. FOR PLAY THERAPY