Basic Information
| Provider Information | |||||||||
| NPI: | 1578210712 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELLE & ME DEVELOPMENTAL AND BEHVAVIORAL SERIVES | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 FARRINGTON RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191512714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846203563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1620 FARRINGTON RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191512714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846203563 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2022 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLWOOD | ||||||||
| AuthorizedOfficialFirstName: | NAESHA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4846203563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.