Healthcare Provider Details

I. General information

NPI: 1053772012
Provider Name (Legal Business Name): ELLEN ELIZABETH BARTOLINI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 WALNUT ST
CHESTER PA
19013-5725
US

IV. Provider business mailing address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 610-499-1204
  • Fax:
Mailing address:
  • Phone: 508-344-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number05869
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: