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General NPI Number Information
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NPI Number | 1912231218
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Entity Type | Individual
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Provider Name | ELLEN SUE ERVIN LCSW, BCD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 345 ADAMS ST 8TH FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11201-3719
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Country | US
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Telephone | 718-260-8514
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Fax |
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Provider Business Mailing Address
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Address Line | 347 PACIFIC ST APT. 4A
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City | BROOKLYN
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State | NY
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Zip | 11217-2240
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Country | US
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Telephone | 917-319-7084
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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 | R052655-1
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License Number State | NY
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