Provider Demographics
NPI:1689799884
Name:ELLMAN, CAROLYN SANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:SANDRA
Last Name:ELLMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:SANDRA
Other - Last Name:FEINBERG-ELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:140 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-799-9509
Mailing Address - Fax:
Practice Address - Street 1:140 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-799-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV48701Medicare ID - Type Unspecified