Provider Demographics
NPI:1700273240
Name:ELLIS, ELAINE V (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:V
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SEYMOUR AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2915
Mailing Address - Country:US
Mailing Address - Phone:347-933-3365
Mailing Address - Fax:347-346-4761
Practice Address - Street 1:3305 SEYMOUR AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2915
Practice Address - Country:US
Practice Address - Phone:347-933-3365
Practice Address - Fax:347-346-4761
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical