Provider Demographics
NPI:1821145129
Name:RESNIK, ELLEN JEAN (MA, LMHC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:JEAN
Last Name:RESNIK
Suffix:
Gender:F
Credentials:MA, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6029
Mailing Address - Country:US
Mailing Address - Phone:617-277-2160
Mailing Address - Fax:
Practice Address - Street 1:496 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2435
Practice Address - Country:US
Practice Address - Phone:617-739-5939
Practice Address - Fax:617-734-5375
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA347294OtherMAGELLAN
MA012897OtherVALUE OPTIONS
MA014602OtherHARVARD PILGRIM
MALM0199OtherBLUE CROSS BLUE SHIELD