MEDICARE: DR. ELLEN FRANCES PRICE PH..D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	PY4422	FL

General Provider Information

NPI Number	:	1235139650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN FRANCES PRICE PH..D.

Provider Business Mailing Address
First Line	:	7025 BERACASA WAY
Second Line	:	SUITE 102C
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3443
Country	:	US
Telephone Number	:	561-479-0603
Fax Number	:	561-479-0604

Provider Business Practice Location Address
First Line	:	7025 BERACASA WAY
Second Line	:	SUITE 102C
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3443
Country	:	US
Telephone Number	:	561-479-0603
Fax Number	:	561-479-0604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	04/29/2014

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