Provider Demographics
NPI:1518080431
Name:WRIGHT, ELLEN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2555
Mailing Address - Country:US
Mailing Address - Phone:215-732-3720
Mailing Address - Fax:215-732-2543
Practice Address - Street 1:2120 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2555
Practice Address - Country:US
Practice Address - Phone:215-732-3720
Practice Address - Fax:215-732-2543
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004936L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWR506856Medicare ID - Type Unspecified