MEDICARE: MRS. ALESSANDRA ELLIS-LODMELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW009134	GA

General Provider Information

NPI Number	:	1932949443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALESSANDRA ELLIS-LODMELL LCSW

Provider Business Mailing Address
First Line	:	121 TIDAL MARSH WAY
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-5809
Country	:	US
Telephone Number	:	912-467-9538
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 TIDAL MARSH WAY
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-5809
Country	:	US
Telephone Number	:	912-467-9538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	06/25/2026

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