Provider Demographics
NPI:1295400257
Name:ELLISON, VERONICA (LCSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:ELLISON
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 1:31 KACHELE ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-2063
Mailing Address - Country:US
Mailing Address - Phone:203-551-7301
Mailing Address - Fax:
Practice Address - Street 1:31 KACHELE ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-2063
Practice Address - Country:US
Practice Address - Phone:203-551-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0108911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical