Vickie R Ellis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904007011

Practice address

Fort George G. Meade, Meddac Headquarters
2480 Llewellyn Ave., Ste 5800
Ft. Meade, MD 20755-5129

Phone

(301) 677-8798

NPI assigned

Apr 8, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hampton Newport News Community Services Board

  • Community/Behavioral Health Agency
  • Hampton, VA
  • NPI 1659424448
  NPD (past)

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1104069061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE STE 5800",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207555129",
            "telephone_number": "301-677-8798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FORT GEORGE G. MEADE, MEDDAC HEADQUARTERS",
            "address_2": "2480 LLEWELLYN AVE., STE 5800",
            "city": "FT. MEADE",
            "state": "MD",
            "postal_code": "207555129",
            "telephone_number": "301-677-8798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "VICKIE",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-08",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "0904007011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49-45573",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Theresa Deck, PT
• Nancy Annette Demetrician, RN
• Susan A Demuth, M.D.
• Swati Manoj Desai
• Amanda Droutsas
• Epes Dental Clinic
• Kathy Ann Espitia
• Denise Evangelista
• Jennifer L Evans, PHARMD
• Roger N Ewonkem, M.D.

• Clinical Social Worker in Ft. Meade, MD
• Providers in Ft. Meade, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.