Provider Demographics
NPI:1881956738
Name:ELLINGTON, TREINA KETURA
Entity type:Individual
Prefix:
First Name:TREINA
Middle Name:KETURA
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CEDAR ST STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5250
Mailing Address - Country:US
Mailing Address - Phone:914-576-5292
Mailing Address - Fax:914-576-4761
Practice Address - Street 1:20 CEDAR ST STE 302
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5250
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:914-576-4761
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator