Carl R. Ellis in Virginia Beach - Clinical Child & Adolescent
Carl R. Ellis - NPI 1114002581
Carl R. Ellis is a Clinical Child & Adolescent in Virginia Beach, Virginia. Carl R. Ellis practices all healthcare services and medical treatments related to Clinical Child & Adolescent. The NPI Number for Carl R. Ellis is 1114002581. The last update date is 2012-09-04.
Carl R. Ellis's current location address is 1020 Independence Blvd, Virginia Beach, Virginia. You can contact this provider via phone number 7576401882 and fax number 7576400253. The mailing address for Carl R. Ellis is 1020 Independence Blvd, Virginia Beach, Virginia. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Carl R. Ellis |
|---|---|
| Address | 1020 Independence Blvd, Virginia Beach, Virginia |
| Phone Number | 7576401882 |
| Fax Number | 7576400253 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER |
|---|---|
| Authorized Official Name | Ellis Richard Carl |
| Credentials | ED.D. |
| Telephone Number | 7576401882 |
NPI Number Detail
| NPI Number | 1114002581 |
|---|---|
| Provider Enumeration Date | 2006-10-26 |
| Last Updated Date | 2012-09-04 |
Provider Mailing Address Detail
| Address | 1020 Independence Blvd |
|---|---|
| City | Virginia Beach |
| State | Virginia (VA) |
| Post Code | 234555500 |
| Phone Number | 7576401882 |
| Fax Number | 7576400253 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical Child & Adolescent |
|---|---|
| Taxonomy | 103Tc2200X |
| Licence No | 810001913 |
|
Definition: A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 260026000 | VA | OPTIMA HEALTH | |
| 7700580 | VA | -- |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Carl R. Ellis by the Centers for Medicare & Medicaid Services?
The Carl R. Ellis has been issued the NPI (National Provider Identifier) 1114002581, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Carl R. Ellis?
The Carl R. Ellis is situated at 1020 Independence Blvd, in the city of Virginia Beach, state of VA, with the zip code 234555500.
What is the Carl R. Ellis's specialty and taxonomy code?
The Carl R. Ellis's specialty is Clinical Child & Adolescent, and the corresponding taxonomy code is 103Tc2200X.
On what date did the Centers for Medicare & Medicaid Services issue the 1114002581 to Carl R. Ellis?
The Carl R. Ellis received its 1114002581 assignment from the Centers for Medicare & Medicaid Services on 2006-10-26.
When was the information pertaining to Carl R. Ellis most recently updated or revised?
The details related to Carl R. Ellis, including its address, specialty, and other relevant information, were last updated or revised on 2012-09-04.