Healthcare Provider Details

I. General information

NPI: 1891173316
Provider Name (Legal Business Name): ELLEN JANE WHALEN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2015
Last Update Date: 07/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 EAGLE ROCK AVE
WEST ORANGE NJ
07052
US

IV. Provider business mailing address

1154 PAPEN RD
BRIDGEWATER NJ
08807-1232
US

V. Phone/Fax

Practice location:
  • Phone: 888-284-2034
  • Fax:
Mailing address:
  • Phone: 908-392-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35S100609000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: