Jennifer Lyn Ellis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

007975 Issued in CT

Practice address

743 South Ave
Bridgeport, CT 06604-5810

Phone

(203) 330-6000

Fax

(203) 382-1435

NPI assigned

May 23, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527033600000",
    "number": "1326539602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "743 SOUTH AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066045810",
            "telephone_number": "203-330-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SOUTH AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066045810",
            "telephone_number": "203-330-6000",
            "fax_number": "203-382-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JENNIFER",
        "middle_name": "LYN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-23",
        "last_updated": "2018-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "007975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elite Home Care Agency LLC
• Ragaa Elkabbani, MBBS
• Judith Elkies, SLP
• Crystal A Ellis
• Elizabeth Anna Ellis, CRNA
• Keith Lawrence Ellis
• Rashaya Tiara Ellis, PHLEBOTOMIST
• Irene Ellison
• Louis Elmo Jr., OTR
• Fady Elshikh, MD

• Clinical Social Worker in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; 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.