Provider Demographics
NPI:1720200751
Name:CARR, ELLEN D (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:D
Last Name:CARR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11812 BRIGHT PSGE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4348
Mailing Address - Country:US
Mailing Address - Phone:410-997-4900
Mailing Address - Fax:410-997-1107
Practice Address - Street 1:10450 SHAKER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1143
Practice Address - Country:US
Practice Address - Phone:410-997-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD019261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical