Active NPI
Wanda Ellis, LMSW
- Social Worker
- Brooklyn, NY
National Provider Identifier
1043570609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 071979-1
- Practice address
- 1 Brookdale PLZ
Brooklyn, NY 11212-3139 - Phone
- (718) 240-8104
- Fax
- (718) 240-6714
- NPI assigned
- May 16, 2012
- Last updated
- May 16, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 071979-1 | NY | Primary |
Addresses
Primary practice location
1 Brookdale PLZ
Brooklyn, NY 11212-3139
Mailing address
965 Home St
Bronx, NY 10459-1935
Phone (718) 240-8104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071979-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337126400000",
"number": "1043570609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "965 HOME ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104591935",
"telephone_number": "718-240-8104",
"fax_number": "718-240-6714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BROOKDALE PLZ",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112123139",
"telephone_number": "718-240-8104",
"fax_number": "718-240-6714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "WANDA",
"name_prefix": "Ms.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-16",
"last_updated": "2012-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "071979-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.