Provider Demographics
NPI:1881713071
Name:LIVINGSTON, ELLEN C (LCSW-C, LICSW)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:C
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-0771
Mailing Address - Country:US
Mailing Address - Phone:301-441-2525
Mailing Address - Fax:301-441-2511
Practice Address - Street 1:7303 HANOVER PARKWAY UNIT C
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-441-2525
Practice Address - Fax:301-441-2511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127231041C0700X, 104100000X
DCLC50078096104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7503874OtherAETNA EAP PROVIDER PIN
MD5472OtherCAREFIRST GHMSI PROVIDER
MD20CVECOtherCAREFIRST PREFERRED PROVI