Provider Demographics
NPI:1316003486
Name:ZASLAW, ELLEN (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ZASLAW
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 1:215 N CAYUGA ST
Mailing Address - Street 2:BOX 46
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4329
Mailing Address - Country:US
Mailing Address - Phone:607-273-0705
Mailing Address - Fax:
Practice Address - Street 1:215 N CAYUGA ST
Practice Address - Street 2:BOX 46
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4329
Practice Address - Country:US
Practice Address - Phone:607-273-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00578616Medicaid
NY00578616Medicaid
NY39973BMedicare ID - Type Unspecified