Provider Demographics
NPI:1316041981
Name:WHIPPLE, ELLEN LUCILLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LUCILLE
Last Name:WHIPPLE
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 1:6928 CHARLOTTE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13750-8375
Mailing Address - Country:US
Mailing Address - Phone:607-278-5525
Mailing Address - Fax:
Practice Address - Street 1:34570 STATE HIGHWAY 10
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13782-1120
Practice Address - Country:US
Practice Address - Phone:607-865-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0735211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical