MEDICARE: ELEANOR EZELL LCSW

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1306296165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR EZELL LCSW

Provider Business Mailing Address
First Line	:	57 W 57TH ST
Second Line	:	SUITE 1007
City	:	NEW YORK
State	:	NY
Zip	:	10019-2802
Country	:	US
Telephone Number	:	212-658-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 PENNOCK AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-5711
Country	:	US
Telephone Number	:	615-649-4444
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	09/02/2022

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