Provider Demographics
NPI:1639220775
Name:NEFF, ELLEN J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:J
Last Name:NEFF
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-0039
Mailing Address - Country:US
Mailing Address - Phone:631-463-3142
Mailing Address - Fax:631-477-1284
Practice Address - Street 1:44210 NORTH RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-5032
Practice Address - Country:US
Practice Address - Phone:631-463-3142
Practice Address - Fax:631-477-1284
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052555-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP2251Medicare ID - Type Unspecified