Healthcare Provider Details

I. General information

NPI: 1285775163
Provider Name (Legal Business Name): ELLEN MARY DELIA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 SCHOOLHOUSE RD
WHITING NJ
08759-3051
US

IV. Provider business mailing address

75 BROWER DR
BRICK NJ
08723-5801
US

V. Phone/Fax

Practice location:
  • Phone: 732-350-2120
  • Fax:
Mailing address:
  • Phone: 732-477-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04630700
License Number StateNJ

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: