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General NPI Number Information
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NPI Number | 1245701226
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Entity Type | Individual
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Provider Name | JODI ELISE ELLSWORTH LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 2 ELLSWORTH DR
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City | LAVALE
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State | MD
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Zip | 21502-4757
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Country | US
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Telephone | 443-912-6153
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Fax |
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Provider Business Mailing Address
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Address Line | 10100 COUNTRY CLUB RD SE
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City | CUMBERLAND
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State | MD
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Zip | 21502-8339
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12713
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License Number State | MD
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