Ellenhorn, Theodore Jacob
Ellenhorn, Theodore Jacob is an individual health care provider with primary practice located at 17 Kellogg Ave Ste 3, Amherst MA 01002-2150. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Ellenhorn, Theodore Jacob can be contacted via phone (413) 256-3075.Contact Information
Primary practice address
17 Kellogg Ave Ste 3
Amherst MA 01002-2150
Phone: (413) 256-3075
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 5069 | Massachusetts |
Profile Details
| NPI number | 1609911544 |
|---|---|
| LBN Legal business name | Ellenhorn, Theodore Jacob |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 20th, 2007 |
| Last updated | Feb 25th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609911544 | NPPES |
| Massachusetts | Other | W04790 | BCBS |
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