Healthcare Provider Details

I. General information

NPI: 1780735548
Provider Name (Legal Business Name): SIDNEY LEE ELLIS LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 CHETWOOD CIRCLE STE 2
TIMONIUM MD
21093-2533
US

IV. Provider business mailing address

2429 CHETWOOD CIRCLE STE 2
TIMONIUM MD
21093-2533
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-3322
  • Fax: 410-744-3326
Mailing address:
  • Phone: 410-744-3322
  • Fax: 410-744-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04411
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: