Provider Demographics
NPI:1780618140
Name:JONES, ELLEN MARIE (LCSW-R)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:JONES
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 1:9 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1619
Mailing Address - Country:US
Mailing Address - Phone:607-226-5621
Mailing Address - Fax:607-296-7554
Practice Address - Street 1:9 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1619
Practice Address - Country:US
Practice Address - Phone:607-226-5621
Practice Address - Fax:607-226-5621
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0765461041C0700X
NY0704171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04207109Medicaid