Provider Demographics
NPI:1376755439
Name:HONNET, ELLEN PORTER (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:PORTER
Last Name:HONNET
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1324
Mailing Address - Country:US
Mailing Address - Phone:617-969-3451
Mailing Address - Fax:617-969-3430
Practice Address - Street 1:19 HARRISON ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1324
Practice Address - Country:US
Practice Address - Phone:617-969-3451
Practice Address - Fax:617-969-3430
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8297103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHOW51466Medicare ID - Type Unspecified