Provider Demographics
NPI:1205006400
Name:YOVANOVICH, ELLIE ANITA (MSW LSW PA AND NJ LS)
Entity Type:Individual
Prefix:MS
First Name:ELLIE
Middle Name:ANITA
Last Name:YOVANOVICH
Suffix:
Gender:F
Credentials:MSW LSW PA AND NJ LS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BREEZY DR
Mailing Address - Street 2:
Mailing Address - City:ERWINA
Mailing Address - State:PA
Mailing Address - Zip Code:18920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-294-5054
Practice Address - Street 1:1055 RIVER ROAD
Practice Address - Street 2:ALTERNATIVES
Practice Address - City:UPPER BLACK EDDY
Practice Address - State:PA
Practice Address - Zip Code:18972
Practice Address - Country:US
Practice Address - Phone:610-294-5054
Practice Address - Fax:610-294-5054
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04636400101Y00000X
PASW125457101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor