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General NPI Number Information
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NPI Number | 1689152233
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Entity Type | Individual
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Provider Name | GWENDOLYN ELLIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/04/2018
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Last Update Date | 08/04/2018
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Provider Practice Location Address
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Address Line | 19 W 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 917-344-0936
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Fax |
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Provider Business Mailing Address
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Address Line | 13437 166TH PL APT 7C
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City | JAMAICA
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State | NY
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Zip | 11434-3812
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Country | US
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Telephone | 718-902-6584
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 103094
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License Number State | NY
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