Provider Demographics
NPI:1154056455
Name:STUMAN, ELLIE DARLINE (LSW)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:DARLINE
Last Name:STUMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 7TH AVE RM 501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4850
Mailing Address - Country:US
Mailing Address - Phone:184-441-5459
Mailing Address - Fax:
Practice Address - Street 1:1200 2ND ST APT 8
Practice Address - Street 2:
Practice Address - City:PEPIN
Practice Address - State:WI
Practice Address - Zip Code:54759-3626
Practice Address - Country:US
Practice Address - Phone:651-247-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN925373461OtherUNITED HEALTHCARE