Provider Demographics
NPI:1629138060
Name:CHANDLER, ELLEN AGREE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:AGREE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 ROUTE 9D
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-3344
Mailing Address - Country:US
Mailing Address - Phone:845-424-3650
Mailing Address - Fax:845-424-3364
Practice Address - Street 1:666 ROUTE 9D
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-3344
Practice Address - Country:US
Practice Address - Phone:845-424-3650
Practice Address - Fax:845-424-3364
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR022138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN11612Medicare ID - Type Unspecified