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General NPI Number Information
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NPI Number | 1285509869
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Entity Type | Individual
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Provider Name | JENNIFER ELLIS LCSW, PMH-C
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Gender | Female
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 98 BURNETT AVE APT 2C
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3159
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Country | US
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Telephone | 973-519-1247
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Fax |
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Provider Business Mailing Address
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Address Line | 4 S ORANGE AVE, PMB #1208
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079
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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 | 44SC05674400
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License Number State | NJ
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