Provider Demographics
NPI:1679500078
Name:ELLSTEIN, CAROL GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:GAIL
Last Name:ELLSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 CRESCENT PL APT 2A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2694
Mailing Address - Country:US
Mailing Address - Phone:517-881-0668
Mailing Address - Fax:
Practice Address - Street 1:1219 CRESCENT PL APT 2A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2694
Practice Address - Country:US
Practice Address - Phone:517-881-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005425103T00000X
PAPS019893103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680A64500OtherBLUE CROSS BLUE SHIELD MI
MI680A64500OtherBLUE CROSS BLUE SHIELD MI