Provider Demographics
NPI:1508510256
Name:GOONE, ELLIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:GOONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:41 MADISON AVE FL 31
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 E 16TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3112
Practice Address - Country:US
Practice Address - Phone:917-854-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1135491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical