Provider Demographics
NPI:1649575051
Name:IMBIANO, ELLEN D (LMHC, CSAT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:D
Last Name:IMBIANO
Suffix:
Gender:F
Credentials:LMHC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VAN WYCK STREET
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2525
Mailing Address - Country:US
Mailing Address - Phone:914-715-2384
Mailing Address - Fax:
Practice Address - Street 1:17 VAN WYCK STREET
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-2525
Practice Address - Country:US
Practice Address - Phone:914-715-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003850101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor