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NPI Code Detail

MEDICARE: MRS. SONYA D ELLIS LCSW

MEDICARE: MRS. SONYA D ELLIS 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
11041C0700XClinical Social Worker213516MA

General Provider Information

NPI Number : 1518003748
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SONYA D ELLIS LCSW
Provider Business Mailing Address
First Line : 280 CHESTNUT ST
Second Line :
City : GARDNER
State : MA
Zip : 01440-2706
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 55 LAKE ST
Second Line :
City : GARDNER
State : MA
Zip : 01440-3876
Country : US
Telephone Number : 508-849-5648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. SONYA D ELLIS LCSW” Practice Location

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