Healthcare Provider Details

I. General information

NPI: 1558061754
Provider Name (Legal Business Name): ELLA JOSEPHINE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CAMP ST
HYANNIS MA
02601-3008
US

IV. Provider business mailing address

6 ARDEN WAY
SOUTH YARMOUTH MA
02664-1609
US

V. Phone/Fax

Practice location:
  • Phone: 833-229-2683
  • Fax:
Mailing address:
  • Phone: 508-776-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2120670
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: