William Bradford Ellis, CASAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

35967 Issued in NY

Practice address

2435 6TH Ave
Troy, NY 12180-2227

Phone

(518) 274-5143

NPI assigned

Jul 12, 2022

Sex

Male

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)

Not enrolled

State licenses

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.

• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Liverpool, NY
  • NPI 1366498768
  NPD (past)

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

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1619601101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 THE MALL ST",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120101224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 6TH AVE",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121802227",
            "telephone_number": "518-274-5143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Franklin St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Schenectady",
            "state": "NY",
            "postal_code": "123052100",
            "country_code": "US",
            "telephone_number": "518-372-7031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "WILLIAM",
        "middle_name": "BRADFORD",
        "credential": "CASAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "35967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Susan Elacqua, M.D.
• Dalia Eldeiry, MD
• Jeanne A Elisha, FNP
• Kara Nili Ellenbogen, M.S.
• Jill Nicole Elliott, SPEECH PATHOLOGIST
• Kimberlee A Elmendorf
• Elizabeth Nadine Elsagga, DO
• Emergency Medicine Physicians of Samaritan, PLLC
• Empire Vision Center Inc
• Endocrinology Troy

• Addiction (Substance Use Disorder) Counselor in Troy, NY
• Providers in Troy, NY by specialty
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; 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.