Active NPI
Cedalia Amber Ellis, LSW
- Social Worker
- Evansville, IN
National Provider Identifier
1043776214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 99089105A
- Practice address
- 410 Mulberry St
Evansville, IN 47713-1231 - Phone
- (812) 436-4243
- NPI assigned
- Feb 13, 2019
- 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 | 99089105A | IN | Primary |
Addresses
Primary practice location
410 Mulberry St
Evansville, IN 47713-1231
Mailing address
415 Mulberry St
Evansville, IN 47713-1230
Phone (812) 423-7791
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99089105A | IN | MD | Social Worker |
| 34009278A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550016000000",
"number": "1043776214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 MULBERRY ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477131230",
"telephone_number": "812-423-7791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 MULBERRY ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477131231",
"telephone_number": "812-436-4243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CEDALIA",
"middle_name": "AMBER",
"name_prefix": "Mrs.",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-13",
"last_updated": "2019-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "99089105A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.