Provider Demographics
NPI:1467589820
Name:ELLIS, BARBARA S (LICSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:S
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:769 PLAIN ST
Mailing Address - Street 2:UNIT I
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2118
Mailing Address - Country:US
Mailing Address - Phone:781-834-7433
Mailing Address - Fax:781-834-7458
Practice Address - Street 1:769 PLAIN ST
Practice Address - Street 2:UNIT I
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2118
Practice Address - Country:US
Practice Address - Phone:781-834-7433
Practice Address - Fax:781-834-7458
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1133951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical