NPIMap

Mary Ann Ellis, ED.S.

Individual provider Active NPI School Psychologist · Dunnellon, FL

NPI 1295042869 · NPPES record last updated Apr 8, 2020

Key facts

NPI
1295042869
Entity type
Individual (NPI type 1)
Primary specialty
School Psychologist 103TS0200X
License
SS 830 (FL)
Practice address
20114 E Pennsylvania Ave
Dunnellon, FL 34432-6033
Phone
(352) 465-2444
Fax
(352) 465-7854
NPI assigned
Sep 2, 2010
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
SS830FLMDMental Health Counselor
SS 830FLMDSchool Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Growing Well Family Behavioral Services School Current Accepting new patients

Locations

20114 E Pennsylvania Ave
Dunnellon, FL 34432
Phone (352) 465-2444

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X SS 830 FL Yes
Mental Health Counselor 101YM0800X SS830 FL

Addresses

Primary practice location

20114 E Pennsylvania Ave
Dunnellon, FL 34432-6033

Mailing address

20114 E Pennsylvania Ave
Dunnellon, FL 34432-6033
Phone (352) 465-2444

Other identifiers

IdentifierTypeStateIssuer
1639229362MedicaidFL

Other providers in Dunnellon, FL

All providers in Dunnellon, FL · School Psychologist in Florida

Sources for this page

Verify at the official NPI Registry.