Healthcare Provider Details

I. General information

NPI: 1174517924
Provider Name (Legal Business Name): ELLEN W BALLERENE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/08/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EDWIN C. MOSES BLVD. SAMARITAN BEHAVIORAL HEALTH, ELIZABETH PLACE, 4TH FLOOR
DAYTON OH
45417-0000
US

IV. Provider business mailing address

601 EDWIN C. MOSES BLVD. SAMARITAN BEHAVIORAL HEALTH, ELIZABETH PLACE, 4TH FLOOR
DAYTON OH
45417
US

V. Phone/Fax

Practice location:
  • Phone: 937-276-8333
  • Fax: 937-276-8339
Mailing address:
  • Phone: 937-276-8333
  • Fax: 937-276-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35080057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: