Healthcare Provider Details

I. General information

NPI: 1851747539
Provider Name (Legal Business Name): ELLEN TAYLOR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CORPORATE PL S SUITE 205
PISCATAWAY NJ
08854-6148
US

IV. Provider business mailing address

165 ESSEX AVE APT 506
METUCHEN NJ
08840-2284
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5000
  • Fax:
Mailing address:
  • Phone: 732-354-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00778600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: