Provider Demographics
NPI:1750534400
Name:SMITH, ELLEN (LCAT, MT-BC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 SINGING WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-8933
Mailing Address - Country:US
Mailing Address - Phone:315-685-9932
Mailing Address - Fax:
Practice Address - Street 1:2143 SINGING WOODS DR
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-8933
Practice Address - Country:US
Practice Address - Phone:315-391-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000333-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000333-1OtherCREATIVE ARTS THERAPIST LICENSE