Provider Demographics
NPI:1639290638
Name:CARELLA, ELLEN (RDO)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:CARELLA
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:VALENTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDO
Mailing Address - Street 1:4 GRANT ST
Mailing Address - Street 2:3L
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4169
Mailing Address - Country:US
Mailing Address - Phone:617-797-4871
Mailing Address - Fax:
Practice Address - Street 1:1 PATRIOT LN
Practice Address - Street 2:UNIT 12
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-2235
Practice Address - Country:US
Practice Address - Phone:978-595-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6021156FX1800X
NY8089156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician