Active NPI
Jennifer Danielle Ellis, PH.D
- Clinical Psychologist
- Baltimore, MD
National Provider Identifier
1043925654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 06673
- Practice address
- 5510 Nathan Shock Dr
Baltimore, MD 21224-6823 - Phone
- (410) 550-6346
- NPI assigned
- Jan 18, 2023
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 06673 | MD | Primary |
Addresses
Primary practice location
5510 Nathan Shock Dr
Baltimore, MD 21224-6823
Mailing address
6201 Greenleigh Ave
Baltimore, MD 21220-2004
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
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680825600000",
"number": "1043925654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6201 GREENLEIGH AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212202004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5510 NATHAN SHOCK DR",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212246823",
"telephone_number": "410-550-6346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JENNIFER",
"middle_name": "DANIELLE",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-18",
"last_updated": "2023-04-07",
"certification_date": "2023-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "06673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.