Provider Demographics
NPI:1891711735
Name:DEAN, ELLEN T (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:T
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-3470
Mailing Address - Country:US
Mailing Address - Phone:646-709-8540
Mailing Address - Fax:
Practice Address - Street 1:261 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-3470
Practice Address - Country:US
Practice Address - Phone:646-709-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076443-11041C0700X
GACSW0050211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical