Healthcare Provider Details

I. General information

NPI: 1205993011
Provider Name (Legal Business Name): STEPHEN DAY ELLIS MSW,PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

1622 NAUDAIN ST
PHILADELPHIA PA
19146-1521
US

V. Phone/Fax

Practice location:
  • Phone: 215-893-0646
  • Fax: 215-732-8454
Mailing address:
  • Phone: 215-893-0646
  • Fax: 215-732-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW000931L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: