Provider Demographics
NPI:1477517795
Name:ELLERY, JANICE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ANN
Last Name:ELLERY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SW 2ND PL
Mailing Address - Street 2:
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-3957
Mailing Address - Country:US
Mailing Address - Phone:954-683-8972
Mailing Address - Fax:954-923-4521
Practice Address - Street 1:214 SW 2ND PL
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-3957
Practice Address - Country:US
Practice Address - Phone:954-683-8972
Practice Address - Fax:954-923-4521
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59672Medicare ID - Type Unspecified