Provider Demographics
NPI:1619367570
Name:ELLIS, ANN MALLOZZI (LMSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MALLOZZI
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MITCHELL AVE
Mailing Address - Street 2:SUITE G-280
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1642
Mailing Address - Country:US
Mailing Address - Phone:607-762-2340
Mailing Address - Fax:607-762-3298
Practice Address - Street 1:33 MITCHELL AVE
Practice Address - Street 2:SUITE G-280
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1642
Practice Address - Country:US
Practice Address - Phone:607-762-2340
Practice Address - Fax:607-762-3298
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089286104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker