Provider Demographics
NPI:1851747539
Name:TAYLOR, ELLEN (LPC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ESSEX AVE APT 506
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2284
Mailing Address - Country:US
Mailing Address - Phone:732-354-6346
Mailing Address - Fax:
Practice Address - Street 1:10 CORPORATE PL S
Practice Address - Street 2:SUITE 205
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-6148
Practice Address - Country:US
Practice Address - Phone:732-235-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NJ37PC00778600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator