Healthcare Provider Details

I. General information

NPI: 1225942444
Provider Name (Legal Business Name): AMEER ELLIS ELLIS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21903 113TH DR
QUEENS VILLAGE NY
11429-2619
US

IV. Provider business mailing address

25 HARRISON ST
FARMINGDALE NY
11735-6808
US

V. Phone/Fax

Practice location:
  • Phone: 646-577-0275
  • Fax:
Mailing address:
  • Phone: 917-974-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: