Provider Demographics
NPI:1750668422
Name:PERRICK, ELLEN WENDY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:WENDY
Last Name:PERRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3131
Mailing Address - Country:US
Mailing Address - Phone:516-992-3000
Mailing Address - Fax:
Practice Address - Street 1:2616 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3131
Practice Address - Country:US
Practice Address - Phone:516-992-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025146-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool