Provider Demographics
NPI:1063417541
Name:BAJOREK, ELLEN M (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:BAJOREK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 FLOYD CURL DR
Mailing Address - Street 2:MEDICAL CENTER TOWER 1, SUITE 803
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3919
Mailing Address - Country:US
Mailing Address - Phone:210-615-9500
Mailing Address - Fax:210-615-9600
Practice Address - Street 1:7950 FLOYD CURL DR
Practice Address - Street 2:MEDICAL CENTER TOWER 1, SUITE 803
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3919
Practice Address - Country:US
Practice Address - Phone:210-615-9500
Practice Address - Fax:210-615-9600
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25820103T00000X
OK768103T00000X
MI6301009400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist