Individual provider Active NPI

David Welford Ellis, PH.D.

  • School Psychologist
  • Salem, NJ
National Provider Identifier
1053451476
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
SI01417 Issued in NJ
Practice address
325 Route 45
Salem, NJ 08079-2045
Phone
(856) 878-0800
Fax
(856) 878-0800
NPI assigned
Feb 7, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X SI01417 NJ
Clinical Child & Adolescent Psychologist 103TC2200X SI01417 NJ
Rehabilitation Psychologist 103TR0400X SI01417 NJ
School Psychologist 103TS0200X SI01417 NJ Primary

Addresses

Primary practice location

325 Route 45
Salem, NJ 08079-2045

Mailing address

325 Route 45
Salem, NJ 08079-2045
Phone (856) 878-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040422001535 NJ Practitioner - Clinical Psychologist 7517953748 Practice locations: Pennsville, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Duke University School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3 Carroll Ave
Pennsville, NJ 08070-2129
Phone (856) 878-0500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
SI01417NJMDClinical Neuropsychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1053451476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 ROUTE 45",
            "city": "SALEM",
            "state": "NJ",
            "postal_code": "080792045",
            "telephone_number": "856-878-0800",
            "fax_number": "856-878-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ROUTE 45",
            "city": "SALEM",
            "state": "NJ",
            "postal_code": "080792045",
            "telephone_number": "856-878-0800",
            "fax_number": "856-878-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DAVID",
        "middle_name": "WELFORD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NJ",
            "license": "SI01417",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NJ",
            "license": "SI01417",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "NJ",
            "license": "SI01417",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NJ",
            "license": "SI01417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NJ

Sources for this page

Verify at the official NPI Registry.