Provider Demographics
NPI:1295921781
Name:ELLINGTON, JARRETT F (PSYD)
Entity type:Individual
Prefix:DR
First Name:JARRETT
Middle Name:F
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3717
Mailing Address - Country:US
Mailing Address - Phone:626-353-9718
Mailing Address - Fax:619-533-3459
Practice Address - Street 1:2525 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 245
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3717
Practice Address - Country:US
Practice Address - Phone:626-353-9718
Practice Address - Fax:619-533-3459
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical