Betty Ellis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW5647 Issued in FL

Practice address

91 Bay Bridge Dr
Gulf Breeze, FL 32561-4468

Phone

(850) 291-0340

Fax

(850) 916-9547

NPI assigned

May 19, 2006

Sex

Female

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)

Enrolled

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1811940638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 BAY BRIDGE DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614468",
            "telephone_number": "850-291-0340",
            "fax_number": "850-916-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 BAY BRIDGE DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614468",
            "telephone_number": "850-291-0340",
            "fax_number": "850-916-9547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BETTY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW5647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly K Durham, CRNA
• Jacqueline Kimberly Duvall, M.A.,BCBA
• Barbara Mary Ebel, MD
• Elaine C Sharp MD PA
• Krystal Eldreth, AP
• Emerald Breeze Counseling LLC
• Emerald Coast Behavior Inc
• Emerald Coast Care System, LLC (Doc-N-A-Box)
• Emerald Coast Pediatric Sleep Consultants, LLC
• Emerald Shores Rheumatology Inc

• Clinical Social Worker in Gulf Breeze, FL
• Providers in Gulf Breeze, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; 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.