Provider Demographics
NPI:1720159429
Name:ELLINGER & ELLINGER PSY DPA
Entity Type:Organization
Organization Name:ELLINGER & ELLINGER PSY DPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-498-5300
Mailing Address - Street 1:16244 S MILITARY TRAIL
Mailing Address - Street 2:SUITE 460
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:561-498-5300
Mailing Address - Fax:561-498-5301
Practice Address - Street 1:16244 S MILITARY TRAIL
Practice Address - Street 2:SUITE 460
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-498-5300
Practice Address - Fax:561-498-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty