Provider Demographics
NPI:1457564114
Name:ZIDE, ELLEN DANIELS (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:DANIELS
Last Name:ZIDE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 FIRST AVENUE
Mailing Address - Street 2:ROOM 306
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4901
Mailing Address - Country:US
Mailing Address - Phone:212-263-6809
Mailing Address - Fax:
Practice Address - Street 1:660 FIRST AVENUE
Practice Address - Street 2:ROOM 306
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4901
Practice Address - Country:US
Practice Address - Phone:212-263-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000437101YM0800X
MA1952103TB0200X
NC0503103TB0200X
CA6116103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral