Provider Demographics
NPI:1316601347
Name:MORAN, ELLEN M (MS)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:ROBICHAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:195 MCGREGOR STREET
Mailing Address - Street 2:UNIT 400
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-206-2700
Mailing Address - Fax:
Practice Address - Street 1:195 MCGREGOR STREET
Practice Address - Street 2:UNIT 400
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-206-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health