Provider Demographics
NPI:1235139650
Name:PRICE, ELLEN FRANCES (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:FRANCES
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 BERACASA WAY
Mailing Address - Street 2:SUITE 102C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3443
Mailing Address - Country:US
Mailing Address - Phone:561-479-0603
Mailing Address - Fax:561-479-0604
Practice Address - Street 1:7025 BERACASA WAY
Practice Address - Street 2:SUITE 102C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3443
Practice Address - Country:US
Practice Address - Phone:561-479-0603
Practice Address - Fax:561-479-0604
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FLPY4422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73978Medicare PIN