MEDICARE: ELLE & ME DEVELOPMENTAL AND BEHVAVIORAL SERIVES

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	103K00000X	Behavior Analyst
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1578210712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLE & ME DEVELOPMENTAL AND BEHVAVIORAL SERIVES

Provider Business Mailing Address
First Line	:	1620 FARRINGTON RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2714
Country	:	US
Telephone Number	:	484-620-3563
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 FARRINGTON RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2714
Country	:	US
Telephone Number	:	484-620-3563
Fax Number	:

Authorized Official
Title or Position	:	OWNER/EXECUTIVE DIRECTOR
Name	:	NAESHA MILLWOOD
Credential	:
Telephone Number	:	484-620-3563

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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