Provider Demographics
NPI:1750774329
Name:MARANCA, ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MARANCA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S ALBANY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5434
Mailing Address - Country:US
Mailing Address - Phone:607-277-1383
Mailing Address - Fax:
Practice Address - Street 1:109 S ALBANY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5434
Practice Address - Country:US
Practice Address - Phone:607-277-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT89391041C0700X
NY084919-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical