Provider Demographics
NPI:1154633634
Name:ELLMAN, CARLY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:ELLMAN
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 1:39 KENILWORTH RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1317
Mailing Address - Country:US
Mailing Address - Phone:914-393-2897
Mailing Address - Fax:
Practice Address - Street 1:39 KENILWORTH RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-1317
Practice Address - Country:US
Practice Address - Phone:914-393-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0190741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical