Active NPI
Cynthia G Ellis, PHD
- Psychologist
- Providence, RI
National Provider Identifier
1831215144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS00677
- Practice address
- 105 Medway Street
Providence, RI 02906 - Phone
- (401) 751-3737
- NPI assigned
- Mar 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS00677 | RI | Primary |
| Psychologist | 103T00000X | 7997 | MA |
Addresses
Primary practice location
105 Medway Street
Providence, RI 02906
Mailing address
PO Box 2418
Providence, RI 02906
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 1, 2025 through Feb 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7997 | MA | MD | Psychologist |
| PS00677 | RI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831215144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2418",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "02906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 MEDWAY STREET",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "02906",
"telephone_number": "401-751-3737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CYNTHIA",
"middle_name": "G",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "RI",
"license": "PS00677",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "7997",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.