Provider Demographics
NPI:1568594323
Name:MENDEL, ELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:MENDEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CENTRAL PARK W APT 12N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8209
Mailing Address - Country:US
Mailing Address - Phone:212-662-4193
Mailing Address - Fax:212-666-0047
Practice Address - Street 1:372 CENTRAL PARK W APT 12N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8209
Practice Address - Country:US
Practice Address - Phone:212-662-4193
Practice Address - Fax:212-666-0047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026706-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1901371OtherOXFORD
NY58327000OtherAETNA
NY032287OtherVALUE OPTIONS
NYNO6211Medicare ID - Type Unspecified