Provider Demographics
NPI:1265597298
Name:BOBRUFF-REESE, ELLEN (MSW, CT LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:BOBRUFF-REESE
Suffix:
Gender:F
Credentials:MSW, CT LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 TOSCANA WAY
Mailing Address - Street 2:APT 725
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5321
Mailing Address - Country:US
Mailing Address - Phone:860-461-6964
Mailing Address - Fax:858-247-5555
Practice Address - Street 1:2525 CAMINO DEL RIO S
Practice Address - Street 2:STE 315
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3784
Practice Address - Country:US
Practice Address - Phone:860-233-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA816081041C0700X
CTCT0010331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCT001033OtherCT LCSW LICENSE NUMBER