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General NPI Number Information
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NPI Number | 1265696025
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Entity Type | Individual
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Provider Name | EDWARD JACOB ELLES II LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 424 W 49TH ST APT 3B
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City | NEW YORK
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State | NY
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Zip | 10019-7213
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Country | US
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Telephone | 808-854-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 424 W 49TH ST APT 3B
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City | NEW YORK
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State | NY
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Zip | 10019-7213
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Country | US
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Telephone | 808-854-5711
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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 | 082680
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License Number State | NY
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