Provider Demographics
NPI:1518265479
Name:ELLIS, DAVID D
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:ELLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 LINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1639
Mailing Address - Country:US
Mailing Address - Phone:781-581-9515
Mailing Address - Fax:781-581-9515
Practice Address - Street 1:89 LINWOOD RD
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-1639
Practice Address - Country:US
Practice Address - Phone:781-581-9515
Practice Address - Fax:781-581-9515
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor