Basic Information
| Provider Information | |||||||||
| NPI: | 1598333965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLIS | ||||||||
| FirstName: | TONI-LEE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14915 BROSCHART RD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019098130 | ||||||||
| FaxNumber: | 3012514666 | ||||||||
| Practice Location | |||||||||
| Address1: | 14915 BROSCHART RD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018384912 | ||||||||
| FaxNumber: | 3012514666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2021 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 22853 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.