Carl Paul Ellerman, MSW, PH.D.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R043185 Issued in NY

Practice address

6315 Fly Rd
Suite 106
East Syracuse, NY 13057-9316

Phone

(315) 437-1687

Fax

(315) 437-1686

NPI assigned

Jul 20, 2008

Last updated

Jul 20, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1216512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216512000000",
    "number": "1427213420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6315 FLY RD",
            "address_2": "SUITE 106",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579316",
            "telephone_number": "315-437-1687",
            "fax_number": "315-437-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6315 FLY RD",
            "address_2": "SUITE 106",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579316",
            "telephone_number": "315-437-1687",
            "fax_number": "315-437-1686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERMAN",
        "first_name": "CARL",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "MSW, PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-20",
        "last_updated": "2008-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R043185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2008; 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.