Provider Demographics
NPI:1952492266
Name:ELLIS, RONALD (PSYD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:ELLIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071
Mailing Address - Country:US
Mailing Address - Phone:954-345-0252
Mailing Address - Fax:954-345-0253
Practice Address - Street 1:1881 UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071
Practice Address - Country:US
Practice Address - Phone:954-345-0252
Practice Address - Fax:954-345-0253
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5083103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59582Medicare ID - Type Unspecified