Provider Demographics
NPI:1790285732
Name:ADAMO, ELLEN M (BCBA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:ADAMO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 WESTWOOD DR APT 2W
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2794
Mailing Address - Country:US
Mailing Address - Phone:617-308-0784
Mailing Address - Fax:
Practice Address - Street 1:3880 SHADY SPRINGS LN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4126
Practice Address - Country:US
Practice Address - Phone:636-244-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015022245103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst