Provider Demographics
NPI:1427213420
Name:ELLERMAN, CARL PAUL (MSW, PHD)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:PAUL
Last Name:ELLERMAN
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 FLY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9316
Mailing Address - Country:US
Mailing Address - Phone:315-437-1687
Mailing Address - Fax:315-437-1686
Practice Address - Street 1:6315 FLY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9316
Practice Address - Country:US
Practice Address - Phone:315-437-1687
Practice Address - Fax:315-437-1686
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0431851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical