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General NPI Number Information
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NPI Number | 1942241617
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Entity Type | Individual
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Provider Name | ELLEN J LOVE LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 96 5TH AVE SUITE 1K
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City | NEW YORK
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State | NY
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Zip | 10011-7605
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Country | US
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Telephone | 917-446-7112
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Fax |
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Provider Business Mailing Address
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Address Line | 515 E 89TH STREET 4K
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City | NEW YORK
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State | NY
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Zip | 10128
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Country | US
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Telephone | 212-860-3949
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | R0540831
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License Number State | NY
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