Provider Demographics
NPI:1174014922
Name:SEVIGNY, ELLEN (MA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:SEVIGNY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 PEARL ST APT 319
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4683
Mailing Address - Country:US
Mailing Address - Phone:207-664-9220
Mailing Address - Fax:
Practice Address - Street 1:726 PEARL ST STE C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3609
Practice Address - Country:US
Practice Address - Phone:120-766-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0108363101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONLC.0108363OtherREGISTERED PSYCHOTHERAPIST