Provider Demographics
NPI:1760991715
Name:ELLIS, MONICA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:STACEY
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:10451 MILL RUN CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5594
Mailing Address - Country:US
Mailing Address - Phone:443-250-3471
Mailing Address - Fax:
Practice Address - Street 1:1900 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5909
Practice Address - Country:US
Practice Address - Phone:443-438-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical