Provider Demographics
NPI:1780820266
Name:WALDMAN, ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:LOEFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:20 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2001
Mailing Address - Country:US
Mailing Address - Phone:516-692-4049
Mailing Address - Fax:516-692-4049
Practice Address - Street 1:20 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2001
Practice Address - Country:US
Practice Address - Phone:516-692-4049
Practice Address - Fax:516-692-4049
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005684-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist