Provider Demographics
NPI:1437636248
Name:STEIN, ELLEN ZIDE (MSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ZIDE
Last Name:STEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1170
Mailing Address - Country:US
Mailing Address - Phone:617-332-4782
Mailing Address - Fax:
Practice Address - Street 1:17 EDGE HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1170
Practice Address - Country:US
Practice Address - Phone:617-332-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1000681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical