Healthcare Provider Details

I. General information

NPI: 1164606133
Provider Name (Legal Business Name): PAULA L ELLMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 DANVILLE COURT
ROCKVILLE MD
20852
US

IV. Provider business mailing address

6420 DANVILLE COURT
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-1515
  • Fax:
Mailing address:
  • Phone: 301-770-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number02055
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number02055
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number02055
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: