Provider Demographics
NPI:1346267135
Name:LADD, MARY ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:LADD
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 1:784 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1619
Mailing Address - Country:US
Mailing Address - Phone:860-523-4450
Mailing Address - Fax:860-523-9537
Practice Address - Street 1:784 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1619
Practice Address - Country:US
Practice Address - Phone:860-523-4450
Practice Address - Fax:860-523-9537
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004231320Medicaid