Provider Demographics
NPI:1811036643
Name:RIE, ELLEN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:D
Last Name:RIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COLONY LANE
Mailing Address - Street 2:
Mailing Address - City:BRATENAHL
Mailing Address - State:OH
Mailing Address - Zip Code:44108
Mailing Address - Country:US
Mailing Address - Phone:216-451-4125
Mailing Address - Fax:216-451-4125
Practice Address - Street 1:17 COLONY LANE
Practice Address - Street 2:
Practice Address - City:BRATENAHL
Practice Address - State:OH
Practice Address - Zip Code:44108
Practice Address - Country:US
Practice Address - Phone:216-451-4125
Practice Address - Fax:216-451-4125
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5619333OtherAETNA PCSP
64636OtherCIGNA PCSP
000000130928OtherANTHEM BCBS
6112217OtherUNITED BEHAV ELLEN D RIE
OH0438477Medicaid
280339OtherPCSP VALUE OPTIONS
0005743288OtherAETNA INS
6112217OtherUNITED BEHAV ELLEN D RIE