Healthcare Provider Details

I. General information

NPI: 1760991715
Provider Name (Legal Business Name): MONICA ELLIS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA STACEY ELLIS NONE

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N HOWARD ST
BALTIMORE MD
21218-5909
US

IV. Provider business mailing address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-6742
  • Fax:
Mailing address:
  • Phone: 443-250-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17041
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: