Provider Demographics
NPI:1720235591
Name:ELLIS, LOUISE MARIE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:MARIE
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 1:83 S BEDFORD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3458
Mailing Address - Country:US
Mailing Address - Phone:914-864-2814
Mailing Address - Fax:914-864-2826
Practice Address - Street 1:83 S BEDFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3458
Practice Address - Country:US
Practice Address - Phone:914-864-2814
Practice Address - Fax:914-864-2826
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059244-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical