Healthcare Provider Details

I. General information

NPI: 1457564114
Provider Name (Legal Business Name): ELLEN DANIELS ZIDE ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 FIRST AVENUE ROOM 306
NEW YORK NY
10016-4901
US

IV. Provider business mailing address

660 FIRST AVENUE ROOM 306
NEW YORK NY
10016-4901
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6809
  • Fax:
Mailing address:
  • Phone: 212-263-6809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000437
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1952
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0503
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: