Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | SI01417 | NJ |
N | 103TC0700X | Clinical Psychologist | SI01417 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | SI01417 | NJ |
N | 103TR0400X | Rehabilitation Psychologist | SI01417 | NJ |
N | 103TS0200X | School Psychologist | SI01417 | NJ |
NPI | 1053451476 |
---|---|
Provider Name | Dr. David Welford Ellis |
First Address | Salem, NJ 08079-2045 |
Second Address | Salem, NJ 08079-2045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |